Nutrition management by a multidisciplinary team for prevention of nutritional deficits and morbidity following esophagectomy

This study evaluated the effects of perioperative nutrition management by a multidisciplinary team on nutrition and postoperative complications of patients with esophageal cancer. A total of 239 patients with esophageal cancer who underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between February 2019 and February 2020 were included in the study. They were divided into the experimental group (120 patients) and the control group (119 patients) using the random number table method. Control group patients received routine diet management and experimental group patients received perioperative nutrition management by a multidisciplinary team. The differences of nutriture and postoperative complications between the two groups were compared. At 3 and 7 days after surgery, the experimental group patients had higher total protein and albumin levels (P<0.05), shorter postoperative anal exhaust time (P<0.05), lower incidence of postoperative gastrointestinal adverse reactions, pneumonia, anastomotic fistula, hypoproteinemia (P<0.05), and lower hospitalization costs (P<0.05) than the control group. Nutrition management by a multidisciplinary team effectively improved the nutriture of patients, promoted the rapid recovery of postoperative gastrointestinal function, reduced postoperative complications, and reduced hospitalization costs.

Caracterización clinicoepidemiológica, diagnóstica e histopatológica de pacientes tratados con esofagectomía por cáncer de esófago / Clinical epidemiological, diagnostic, histological and pathological characterization of patients treated with esophagectomy due to esophagus cancer

Introducción: El cáncer de esófago se manifiesta clínicamente en etapas avanzadas y presenta gran letalidad. Objetivo: Caracterizar a los pacientes operados de cáncer de esófago según variables epidemiológicas, clínicas, diagnósticas e histopatológicas. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 87 pacientes con cáncer de esófago, operados en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora de Santiago de Cuba, en el periodo 2014-2018. Resultados: Dicha afección predominó en pacientes del sexo masculino (94,2 %) entre los 65 y 74 años de edad (37,9 %); el tipo histológico más frecuente fue el carcinoma epidermoide (89,6 %) y la localización en el tercio medio (49,4 %). Los hábitos tóxicos que primaron fueron el tabaquismo (87,4 %) y el consumo de alcohol (75,8 %). La disfagia y la pérdida de peso se manifestaron en 73,5 y 66,6 % de la serie, respectivamente. El diagnóstico se realizó mediante imágenes, tales como esofagograma, tomografía contrastada de tórax, abdomen y pelvis; así como por medio de endoscopia y biopsia. Conclusiones: Se demostró que los hombres son los más afectados y es más frecuente el diagnóstico en mayores de 60 años de edad. Se observó el vínculo con el hábito de fumar y el consumo de alcohol. La disfagia es el síntoma más común y tardío de la enfermedad. El estudio de las características clínico-histológicas de los pacientes con cáncer de esófago permite un adecuado enfoque diagnóstico de esta afección, así como el desarrollo de acciones de salud preventivas sobre los principales factores de riesgo identificados.

Introduction: The esophagus cancer is clinically manifested in advanced stages and presents great lethality. Objective: To characterize the patients operated on esophagus cancer according to epidemiological, clinical, diagnostic, histological and pathological variables. Methods: An observational, descriptive and cross-sectional study of 87 patients with esophagus cancer was carried out; they were operated in the General Surgery Service of Saturnino Lora Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, in the period 2014-2018. Results: This affection prevailed in patients from the male sex (94.2 %) between the 65 and 74 years (37.9 %); the most frequent histhologic type was the squamous cell carcinoma (89.6 %) and the localization in the mean third (49.4 %). The toxic habits that prevailed were nicotine addiction (87.4 %) and consumption of alcohol (75.8 %). The dysphagia and loss of weight showed in 73.5 and 66.6 % of the series, respectively. The diagnosis was carried out by means of images, such as esophagogram, chest, abdomen and pelvis contrast tomography, as well as by means of endoscopy and biopsy. Conclusions: It was demonstrated that men are the most affected and it is more frequent the diagnosis in those over 60 years. The link with the habit of smoking and consumption of alcohol was observed. The dysphagia is the most common and late symptom of the disease. The study of clinical, histological and pathological characteristics of patients with esophagus cancer allows an appropriate diagnostic approach of this affection, as well as the development of preventive health actions about the main identified risk factors.

Predictores de complicaciones y muerte en pacientes con esofagectomía por cáncer de esófago / Predictors of complications and death in patients with esophagectomy due to esophagus cancer

Introducción: La morbilidad y la mortalidad continúan siendo altas a escala mundial como consecuencia de la esofagectomía programada por cáncer de esófago. Objetivo: Identificar los factores predictores de complicaciones posquirúrgicas y de muerte, la estadía hospitalaria y las causas de muerte en la población estudiada. Método: Se efectuó un estudio de cohorte de 81 pacientes con diagnóstico de cáncer de esófago, atendidos en los hospitales Saturnino Lora y Dr. Juan Bruno Zayas Alfonso de la provincia de Santiago de Cuba desde enero de 2010 hasta diciembre de 2019, de los cuales se escogió una muestra aleatoria de 68. Para identificar los factores predictivos asociados con las complicaciones y la mortalidad se definieron 2 cohortes de enfermos: los expuestos y los no expuestos a los factores de interés, tales como la realización de toracotomía, las reintervenciones, además de las complicaciones médicas y quirúrgicas infecciosas. Se utilizó el método estadístico de bondad de ajuste de Hosmer-Lemeshow con un nivel de significación α= 0,10. Resultados: Si se realiza toracotomía, la probabilidad de que se desarrollen complicaciones quirúrgicas infecciosas es 2,3 veces mayor que si no se lleva a cabo el proceder; asimismo, el riesgo de fallecer por dichas complicaciones (p=0,024), en contraposición a cuando no se presentan, asciende a 370,0 % (IC 90 %: 1,5-14,8). Conclusión: La realización de toracotomía se establece como factor predictor de complicaciones y la presencia de reintervenciones y de complicaciones médicas y quirúrgicas infecciosas como predictores de muerte en la esofagectomía programada.

Introduction: Morbidity and mortality continue being high worldwide as consequence of the esophagectomy programmed due to esophagus cancer. Objective: To identify the predictor factors of postsurgical and death complications, hospitalization and death causes in the studied population. Method: A cohort study of 81 patients with diagnosis of esophagus cancer was carried out. They were assisted in Saturnino Lora and Dr. Juan Bruno Zayas Alfonso hospitals in the province of Santiago de Cuba from January, 2010 to December, 2019, of which a random sample of 68 was chosen. To identify the prediction factors associated with the complications and mortality 2 cohorts of sick patients were defined: the exposed and those not exposed to interest factors, such as the thoracotomy realization, reinterventions, besides the infectious medical and surgical complications. The statistical method of Hosmer-Lemeshow was used with a significance level of α = 0,10. Results: If thoracotomy is carried out, the probability that infectious surgical complications are developed is 2.3 times more that if it is not carried out; also, the risk of dying due to this complications (p=0.024), in opposition to when they are not presented, ascends to 370.0 % (IC 90 %: 1.5-14.8). Conclusion: The thoracotomy realization is established as predictor factor of complications and the presence of reinterventions and infectious medical and surgical complications as death predictors in the programmed esophagectomy.

Impact of statistical uncertainty on esophagus cancer plan for dose to water and dose to medium / 中国辐射卫生

Objective To study the dosimetry effect of Dw and Dm middle and lower esophageal cancer in Monaco treatment planning system (TPS). Methods 30 patients with T3N0M0StageⅡa middle and lower esophageal cancer were selected for experiment. For each patient, optimize the plan using dose to water (Dw) and dose to medium (Dm) dose calculation mode, then rescale prescription dose to 95% volume of PTV. Compare the difference in the two mode, conformity index (CI), Homogeneity index (HI), Mean dose (Dmean), Minimum dose (Dmin), Maximum dose (D2), Dose to Organ at risk (OAR), MU, Optimization time, photon usage, and QA results of MatriXX and Arc Check. Use SPSS for multivariate analysis. Results In the dose evaluation of the middle and lower esophageal cancer cases under different dose calculation methods, the spinal cord, trachea, V20 of the whole lung, and D2 of the liver have significant dosimetric differences, the dose value, the sequential dose results were compared as (37.92 ± 1.11)/(35.85 ± 1.08), (59.91 ± 1.43)/(60.25 ± 0.98), (22.52 ± 1.75)/(21.38 ± 2.01), (42.89 ± 0.52)/(41.73 ± 0.58). In the comparison of dose cloud distribution, the difference is mainly located in the cavity and the inner wall of the lung in the target area, the dose in the target cavity in the Dw group is higher than that in the Dm group. The dose in the inner and outer walls of the lung cavity in the Dw group are slightly adducted than that in the Dm group, especially in the central area.Dose QA of MartiXX (3%-3 mm) and Arc Check (2%-2 mm) with different dose calculation methods of 60 plans of 30 cases have all passed clinical requirements. Dm Group is better than Dw group. Conclusion It is recommended to use Dm dose calculation method for Monaco 5.11 TPS in the condition of treatment planning for middle and lower esophageal cancer.

Caracterización clínica, epidemiológica y anatómica del cáncer de esófago / Clinical, Epidemiological and Anatomical Characterization of Esophagus Cancer

Introducción: El cáncer de esófago es una enfermedad muy frecuente con tasas de supervivencia desalentadoras, debido a su naturaleza extremadamente agresiva. Objetivo: Caracterizar clínica, epidemiológica y anatómicamente a los pacientes con cáncer de esófago. Método: Se realizó un estudio descriptivo de casos clínicos que acudieron al servicio de Gastroenterología del Hospital Dr. Juan Bruno Zayas Alfonso, en el período comprendido entre junio -noviembre del año 2018. El universo de estudio estuvo conformado por el total de los pacientes de ambos sexos cuya cifra ascendió a 35. Resultados: El grupo de edad que predominó en ambos sexos fue el de 70 años y más, con 37,1 por ciento entre los hombres y 17,1 por ciento en las mujeres. Los hombres fueron los más afectados (68,6 por ciento). La localización anatómica que prevaleció fue a nivel del tercio inferior en un 37,1 por ciento entre los hombres y un 17,1 por ciento entre las féminas. El 57,1 por ciento resultó encontrarse bajo peso, en su mayoría presentaron el esófago de Barret como antecedente patológico personal, acompañado de odinofagia en el 88,6 por ciento de los pacientes. Conclusiones: El estudio permitió caracterizar a los pacientes con cáncer de esófago según variables clínicas, epidemiológicas y anatómicas. Aparece con mayor frecuencia en las últimas décadas de la vida y en etapas avanzadas de la enfermedad, se localiza con mayor frecuencia en el tercio inferior y asociados a antecedentes patológicos personales(AU)

Introduction: Esophageal cancer is a very frequent disease. Due to its extremely aggressive nature, it presents poor survival rates. Objective: To characterize clinically, epidemiologically and anatomically patients with esophageal cancer. Method: A descriptive study was carried out with clinical cases that attended the gastroenterology service at Dr. Juan Bruno Zayas Alfonso Hospital, in the period between June and November 2018. The study population was made up of the total number of patients of both sexes, whose number amounted to 35. Results: The age group that predominated in both sexes was 70 years and over, accounting for 37.1 percent among men and for 17.1 percent among women. Men were the most affected (68.6 percent). The anatomical location that prevailed was the level of the lower third, accounting for 37.1 percent among men and for 17.1 percent among women. 57.1 percent turned out to be underweight; most of them presented Barrett esophagus as a personal pathological history, accompanied by odynophagia in 88.6 percent of the patients. Conclusions: The study allowed characterizing patients with esophageal cancer according to clinical, epidemiological and anatomical variables. It appears more frequently in the last decades of life and in advanced stages of the disease. It is most frequently located in the lower third and associated with a personal pathological history(AU)

Dosimetric comparison between modulated arc therapy and static intensity modulated radiotherapy in thoracic esophageal cancer: a single institutional experience

PURPOSE: The objective of this study was to compare dosimetric characteristics of three-dimensional conformal radiotherapy (3D-CRT) and two types of intensity-modulated radiotherapy (IMRT) which are step-and-shoot intensity modulated radiotherapy (s-IMRT) and modulated arc therapy (mARC) for thoracic esophageal cancer and analyze whether IMRT could reduce organ-at-risk (OAR) dose. MATERIALS AND METHODS: We performed 3D-CRT, s-IMRT, and mARC planning for ten patients with thoracic esophageal cancer. The dose-volume histogram for each plan was extracted and the mean dose and clinically significant parameters were analyzed. RESULTS: Analysis of target coverage showed that the conformity index (CI) and conformation number (CN) in mARC were superior to the other two plans (CI, p = 0.050; CN, p = 0.042). For the comparison of OAR, lung V5 was lowest in s-IMRT, followed by 3D-CRT, and mARC (p = 0.033). s-IMRT and mARC had lower values than 3D-CRT for heart V30 (p = 0.039), V40 (p = 0.040), and V50 (p = 0.032). CONCLUSION: Effective conservation of the lung and heart in thoracic esophageal cancer could be expected when using s-IMRT. The mARC was lower in lung V10, V20, and V30 than in 3D-CRT, but could not be proven superior in lung V5. In conclusion, low-dose exposure to the lung and heart were expected to be lower in s-IMRT, reducing complications such as radiation pneumonitis or heart-related toxicities.

The research progress of relationship between body mass index and esophagus cancer / 中国基层医药

The effect of body mass index (BMI) on the incidence rate and prognosis of esophageal cancer is one of the significant subjects of clinical research about esophageal cancer in recent years.Researchers have attempted to use BMI to predict the risk and prognosis of esophageal cancer.However,no consensus has yet been reached.In this article,the author reviewed related articles published at home and abroad during the last decade to explore the correlation between BMI and esophageal cancer.

Therapeutic effects and survival quality of raltitrexed and radiotherapy in esophagus cancer / 中国生化药物杂志

Objective To investigate the clinical effect and survival quality of raltitrexed and radiotherapy in treatment of esophagus cancer. Methods 100 cases with esophagus cancer were selected. There were 50 cases using raltitrexed combined with concurrent radiotherapy as observation group. Others were treated with 5-Fu combined with concurrent radiotherapy as control group. The clinical therapeutic effect and survival situation of two groups were evaluated. Results After treatment, the total response rate of observation group (86.0%) was higher than control group (58.0%), the differences between the two groups was statistical difference(P<0.05).The one- and two-year survival rates in observation group were higher than control group (χ2 = 4.32, 7.954, P=0.038, 0.005<0.05).There was no significant difference between the two groups in incidence rate of acute esophagitis, acute bone marrow suppression and acute skin reaction. Conclusion The clinical therapy of raltitrexed plus radiotherapy in treatment of esophagus cancer is distinct, and improve the survival time and the quality of life of patients.

Efficacy and safety of stents loaded with 125I seeds for patients with advanced esophageal cancer: a meta-analysis / 中华放射医学与防护杂志

Objective To evaluate the clinical effectiveness and safety of stents loaded with 125I seeds compared to conventional stents.Methods Literatures were searched in PubMed,EMbase,Cochrane Library,CBM,CNKI,Wanfang Data and other electronic databases from inception to November 2016.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted data and assessed quality of the included studies independently.Meta-analyses were performed using RevMan 5.3.Results A total of five RCTs and 14 CCTs involving 1 211 patients were included.The mean survival time of the 125I stent group was significantly higher than that of the control group [mean difference =4.11,95％ CI (2.16-6.07)P ＜0.001].The incidence of restenosis after 3:The available data showed that the incidence of re-staging of 125I stent in the treatment group was lower than that of the normal stent group [RR =0.23,95％ CI(0.12-0.62),P =0.002].Postoperative bleeding [RR =0.80,95％CI (0.52-1.23),P=0.30];Postoperative pain[RR=1.06,95％CI(90.88-1.27),P=0.55];postoperative stent shift [RR =0.53,95％ CI(0.27-1.05),P =0.07].The difference of incidence of complications was not statistically significant.There was no difference in the incidence of complications between the two groups.Conclusions The available data suggest that 125I stent is superior to common stent in the treatment of advanced esophageal cancer.There are no differences found in the incidence of complications between 125I stent and conventional stent.However,due to the limited quality of the included studies,more high-quality and multicenter-based studies are needed to verify the above conclusion.

Research on DNA Hydroxymethylation Modification in Digestive System Carcinoma / 现代生物医学进展

DNA hydroxymethylation modification is an important part of genome epigenetic regulation.The demethylation process from 5-methylcytosine (5-mC) to 5-hydroxymethylcytosine (5-hmC) is catalyzed by Tet protein.Abnormal genomic methylation leads to the occurrence of a variety of tumors.Hydroxymethylation is modified as a kind of demethylation and is inseparable from tumorigenesis.The expression of 5-hmC changes accompanied with the development and progression of digestive system tumors,which may be associated with the TET protein family and IDH mutation.It suggested that DNA hydroxymethylation is involved in the development and progression of digestive system tumors.This paper reviews the relationship between DNA hydroxymethylation and digestive system tumors,and aims to provide a new direction for the study of Hydroxymethylation modification in digestive system tumors.

Caracterización de pacientes con cáncer de esófago en el bienio 2013-2014 / Characterization of patients with esophagus cancer in the biennium 2013-2014

Introducción: el cáncer de esófago es uno de los más "agresivos" y de menor supervivencia a escala mundial; en Cuba es de 3,9 por cada 100 000 habitantes.Objetivo: caracterizar a los pacientes con ese diagnóstico, según variables seleccionadas. Métodos: se realizó un estudio descriptivo y transversal de 51 pacientes ingresados con neoplasia de esófago en el Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde enero de 2013 hasta diciembre de 2014. Resultados: predominaron los afectados de 60-69 años (39,1 %), el sexo masculino (84,3 %), los que refirieron dificultad para tragar (76,6 %) y el carcinoma epidermoide como forma histológica (76,5 %). Durante su estadía en la institución fallecieron 19,6 % de los pacientes. La disfagia se presentó en estadios muy avanzados de la enfermedad. Conclusiones: a pesar de la importancia y vigilancia de los factores de riesgo del cáncer de esófago en Cuba, aún se diagnostica en etapas avanzadas cuando las posibilidades terapéuticas son muy reducidas y poco eficaces.

Introduction: the esophagus cancer is one of the "most aggressive" and of less survival worldwide; in Cuba it is 3.9 out of 100 000 inhabitants. Objective: to characterize the patients with that diagnosis, according to selected variables. Methods: a descriptive and cross-sectional study of 51 patients admitted with esophagus neoplasm in "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 2013 to December, 2014. Results: the age group 60-69 (39.1%), the male sex (84.3%), those referring difficulty to swallow (76.6%) and the epidermoid carcinoma as histologic type (76.5%), prevailed. During their stay in the institution, 19.6% of the patients died. The dysphagia was presented in very advanced stages of the disease. Conclusions: in spite of the importance and surveillance of the esophagus cancer risk factors in Cuba, it is still diagnosed in advanced stages when the therapeutic possibilities are very reduced and not very effective.

Over-expression of miR-141 increases the radiosensitivity of esophagus cancer cells / 中华放射医学与防护杂志

Objective To investigate the role and potential molecular mechanism of the radiosensitivity of esophagus cancer cells.Methods miR-141 mimics or its negative control was transfected into esophagus cancercells KYSE-150,respectively.Radiosensitivity of esophagus cancer cells was determined by CCK-8,flow cytometry and colony formation assay.The expression level of miR-141 was determined by qRT-PCR.Western blot was used to detect the expressions of proliferation-related protein Ki67 and apoptosis-related proteins Bax and Bcl-2.Results After radiation,the expression of miR-141 was decreased in KYSE-150 cells in a dose-dependent manner (t =2.57-8.96,P ＜ 0.05).Upregulation of miR-141 significantly suppressed cell proliferation and colony formation and promoted apoptosis,indicating that overexpression of miR-141 enhanced the radiosensitivity of KYSE-150 cells(t =3.24,P ＜0.05).In addition,the miR-141 mimic significantly reduced the expressions of Ki67 and Bcl-2 protein (t =6.56,8.24,P ＜ 0.01) and inhibited the expression of Bax protein compared with miR-control group (t =3.24,P ＜ 0.01).Conclusions Over-expression of miR-141 enhances the radiosensitivity of esophagus cancer cells by regulating the expressions of proliferation-related protein Ki67 and apoptosisrelated proteins Bax and Bcl-2.

Postoperative analgesic effect of sub anesthetic dose of ketamine combined with sufentanil after esophagus cancer resection / 临床麻醉学杂志

Objective To evaluate the effects of sub anesthetic dose of ketamine combined with sufentanil on postoperative patient-controlled intravenous analgesia (PCIA)in patients undergoing radical resection of esophageal cancer.Methods Ninety patients,ASAⅠorⅡ,aged 55-75 years old,se-lected for radical resection of esophageal cancer were randomly divided into three groups:group S1,group S2,group SK,30 patients in each group were treated with PCIA.Group S1,2 μg/kg sufentanyl;group S2,2.5 μg/kg sufentanyl;group SK 2 μg/kg sufentanyl+90 μg·kg-1·h-1 ketamine.6 mg of granisetron was added to each group,and then diluted into 100 ml of normal saline.All patients were administered load-ing doses of 5 ml analgesics 30 min before the end of the operation.The VAS score,Ramsay sedation score, SBP,DBP,HR,SpO2 and adverse effects were recorded respectively at 4,8,24 and 48 hours after opera-tion.The total times of pressing PCIA were also recorded in 48 h after operation.Results There was no statistically significant difference in Ramsay sedation score,SBP,DBP,HR and SpO2 at 4,8,24,48 hours after operation in the three groups.Compared with group S1,the VAS score and total number of pressing PCIA times in groups SK and S2 were significantly lower in 48 h after operation (P <0.05).Compared with group S2,VAS score and the total number of pressing PCIA times in group SK were significantly de-creased in 48 h after operation (P <0.05).Two patients from group SK occurred respiratory depression 48 h after operation.There was no statistically significant difference in incidence of adverse effects in the three groups.Conclusion Sub anesthetic dose of ketamine combined with sufentanil on PCIA can reduce postoper-ative sufentanil consumption and significantly relieve the postoperative pain in patients undergoing radical re-section of esophageal cancer.The analgesic effect is better than using sufentanil alone.

Contrast analysis on prognosis of three-field lymph node dissection and two-field lymph node dissection for up-per thoracic esophageal carcinoma / 局解手术学杂志

Objective To explore and analyze the prognosis of three-field lymph node dissection and two-field lymph node dissection for upper thoracic esophageal carcinoma. Methods 120 patients with esophageal carcinoma who were accepted by our hospital from October 2010 to October 2011 were selected as the research subject. They were randomly and equally divided into the three-field lymph node dissec-tion group and the two-field lymph node dissection group. Contrast the rate of lymph nodes metastasis, rate of surgical survival and complica-tions of two groups after treatment. Results After the operation treatment, cervical lymph node and mediastinal lymph node metastasis rates in were 18. 33% and 20. 00% respectively, and the total incidence of complications is 30. 00%. They were all lower than two-field lymph node dissection group. Meanwhile, the survival rate of three-field lymph node dissection group was 83. 33% which was obviously higher than 58. 33% in the two-field lymph node dissection group with a statistical significance (P<0. 05). Conclusion Three-field lymph node dis-section can effectively improve the prognosis and clinical curative effect in treatment of upper thoracic esophageal carcinoma.

Clinical study on abdominal lymph node metastasis from thoracic esophagus carcinoma / 中国肿瘤临床

Objective:To analyze the metastasis rule of abdominal lymph node from thoracic esophagus carcinoma. Methods:The abdominal lymph node data on 164 patients who had undergone resection of thoracic esophageal carcinoma were analyzed retro-spectively. Grouping was based on the upper, middle, and lower thoracic esophagus. Differences in tumor infiltration depth, differentiat-ed degree, pathological type, pathological stage, and metastasis rate of the abdominal lymph node among the three groups were com-pared. The metastasis rates of the abdominal lymph nodes among the different tumor infiltration depths, differentiated degrees, and path-ological types were also compared. Results:The base condition of tumor infiltration depth, differentiated degree, pathological type, and pathological stage has no statistical significance among the upper, middle, and lower thoracic esophagus. The metastasis rate of the ab-dominal lymph node also has no statistical significance among the three groups (upper, 6.9%;middle, 27.4%;and lower, 39.6%). More-over, the metastasis rate of the abdominal lymph node has no statistical significance among the different tumor infiltration depths, differ-entiated degrees, and pathological types. Conclusion:A special bound lymph node metastasis was present in the esophageal carcinoma. If the tumor in the upper thoracic esophagus infiltrated the submucosa, then it could bound metastasize down to the abdominal lymph node by the lymphatic capillary net. The majority of the esophageal carcinoma was more than T1b period when diagnosed. The tumor has infiltrated the submucosa. Thus, early stage, well-differentiated, and upper thoracic esophageal carcinoma does not indicate mini-mal metastasis of the abdominal lymph node. Routine abdominal lymph node dissection through radical surgery for esophageal carcino-ma was necessary.

Neoplasia de esôfago com endocardite infecciosa: relato de caso / Esophagus cancer and infectious endocarditis

Paciente do sexo masculino, 55 anos de idade, com dor lombar intensa e febre vespertina há 20 dias, relatava perda ponderal de 30 quilos em três meses. Exame físico sem alterações na admissão no Hospital Servidor Público Estadual Francisco Morato de Oliveira (HSPE-FMO), em São Paulo. Na investigação etiológica desta febre foi colhida hemocultura, sendo esta positiva para Streptococcus bovis (que é frequentemente associado com malignidade do trato gastrointestinal e pólipos colônicos). Solicitado, por isso, um ecocardiograma transesofágico, pois o ecocardiograma transtorácico era normal. O ecocardiograma transesofágico evidenciou, além de insuficiência mitral e aórtica importante, presença de vegetações nas mesmas valvas, tendo como diagnóstico final uma endocardite bacteriana infecciosa. Foi iniciada antibioticoterapia adequada para o paciente com teicoplamina e gentamicina. O paciente apresentou melhora clínica e permaneceu afebril por 28 dias. Com base na positividade da hemocultura para Streptococcus bovis, foi indicada colonoscopia, a qual evidenciou: moléstia diverticular hipertônica dos cólons, pólipos sésseis de cólon direito e pólipo séssil de reto (realizada polipectomia). O exame anatomopatológico evidenciou adenoma tubular com displasia epitelial de baixo grau em cólon direito e adenoma tubuloviloso com displasia epitelial de baixo grau em reto. O paciente realizou ainda endoscopia digestiva alta (EDA) com cicatriz e úlcera em atividade no esôfago distal, hérnia hiatal, gastrite leve de antro e úlcera bulbar em atividade. Foram realizadas biópsias das úlceras, as quais revelaram adenocarcinoma moderadamente diferenciado com embolização linfática multifocal de esôfago.

Anastomotic fistula of esophagus cancer and cardiac cancer / 国际外科学杂志

Objective To explore the cause of anastomotie fistula after esophagus cancer and cardiac cancer operation and its prevention and treatment.Methods After excising the tumors,the esophagogastrostomy was performed in 60 cases,in which the cervical anastomose in 48 cases and intrathoracic anastomose was adopted in 12 cases.We retrospectively analyzed its prevention and treatment. Results Caevial anastomose in 48 cases,4 patients with anastomotic fistula in the died,while none of 12 cases in the cervical anastomose died. Conclusions Careful procedure and improving the anastomotic methods are the key factors to reduse the anastomotic fistula,the accurate control of infection and full nutritive support are the effective methods to decrease the mortality rate of this disease.

Lewis surgery in treatment of the lower two-thirds of the esophagus cancer

Background: Lewis surgery has been applied in the Department of Digestive Surgery, Viet-Duc hospital since 1991 and became routine surgery in the treatment of the lower two-thirds of the esophagus cancer. Objective: To present Lewis technique and results of operation in treating the lower two-thirds of the esophagus cancer. Subjects and methods: The study was carried out on 90 patients (86 men and 4 women) with the lower two-thirds of the esophagus cancer operated by the Lewis\u2019s technique. The average age of these patients was 52.3 \xb1 9.2. \r\n', u'Results: Disease stages: stage I: 2 cases (2.2%), stage IIA: 23 cases (25.6%), stage IIA: 23 cases (25.6%), stage IIB: 10 cases (11.1%), stage III: 42 cases (46.7%), stage IV: 13 cases (14.4%). There were three cases of postoperative death (5.6%). 34 cases had surgical complications or complications after surgery. The average survival time of patients after surgery was 23.8 months \xb1 2.8. Postoperative survival time of 1 year, 2 years, 3 years, 5 years was 58.2%, 39.2%, 23.4% and 12.0% respectively.\r\n', u'Conclusion: Mortality and postoperative complications of the surgery were low. So it should be selected for the treatment of the lower two-thirds of the esophagus cancer. The surgery helped 96.5% of patients to eat normally again. 5-year survival time after surgery was low because of diagnosis and surgery in late stages\r\n', u'\r\n', u'

Clinical significance of multidruge resistance gene expression in esophagus and cardiac cancer / 肿瘤研究与临床

Objective To explore the relationship between expression of MDR1 gene in human esophageal and cardiac cancer and clinicopathological changes. Methods From Jan 2 000 to Dec 2001, a total of 161 patients with esophageal or cardiac carcinoma were recruited, and MDR1 were assayed by RT-PCR. Fresh tumor tissues were surgically resected without chemotherapy before operation. Results The positive rate of MDR1 was 34.78 % (56/161). Among them 5 cm 38.54 %, invasion to muscular layer 30.77 %, invasion to tunica serosa 35.14 %, squamous cell carcinoma 27.27 %, adenocarcinoma 41.67 %, lymphonode metastasis positive 35.19 %, negative 33.96 %, stage Ⅰ,Ⅱ 33.33 %, stage Ⅲ, Ⅳ 35.58 %. The correlation between MDR1 expression and the age and sex of patients, Tumor size depth of invasion histologic types lymph node involvement and TNM, was not significant. Conclusion Because of highly expressive level of MDR1 gene in untreated esophageal and cardiac carcinoma, we should choose appropriate chemotherapeutic regimen for esophageal and cardiac cancer. The expression of MDR1 gene in untreated cancer was independented of morphologic prognostic indexes without correlation between MDR1 gene expression and morphological indexes.

Separation of HSP70-peptide compound and the expression of HSP70 in esophagus cancer tissue / 基础医学与临床

Objective The aim is to expore the expression of HSP70 in human esophagus cancer and introduce method of separation of HSP70-peptide compound.Methods The expression of human HSP70 RNA in human(esophagus) cancer was hybridized with P17 probe by Northern blot.The HSP70-peptide complex was isolated by(affinity) chromatography.Results HSP70 mRNA was detected in human esophagus cancer tissue at much more higher level than corresponding normal tissue;HSP70-peptide compound are separated from esophagus cancer of human body.Conclusion This research not only testified the strong expression of HSP70 in esophagus cancer,but also supplied a practical method of extraction and purification of HSP70-peptide compound of tumor origin.This study makes a starting point for further research in this field.