[Enoxaparin for the prevention of post surgical pulmonary embolism].

OBJECTIVE: To evaluate the efficacy and safety of the administration of enoxaparin, a low molecular weight heparin (LMWH), in the prevention of post surgical deep vein thrombosis (DVT) and pulmonary embolism (PE). METHODS: 1928 patients hospitalized for general surgery were randomly divided into: (1) test group (n = 960) to receive enoxaparin (40 mg, s.c., 12 hours before and after surgery, then once daily for 7 consecutive days); (2) control group (n = 968) without intervention. The incidence of DVT,PE and bleeding were recorded for statistical analysis during hospitalization and a 2 months follow-up after discharge. RESULTS: (1) No significant difference was found between the two groups in age, sex, average body mass index, type of surgery, and DVT / PE risk factors (obesity, varicose veins, and history of: venous thrombosis, chronic obstructive pulmonary disease, chronic heart failure, and hormone therapy). The percentage of non-malignant / malignant tumor surgery were 36.5% / 63.5% (average operation time 2.3 hours) in control group and 35.6% / 64.4% (2.2 hours) in test group (both P > 0.05). (2) During the hospitalization period, 59 cases (incidence=6.1%) of DVT and 14 cases (incidence=1.4%) of PE (among them 6 were fetal, 42.8% of all PE cases) were found in the control group, while 28 cases of DVT (2.9%) and 3 cases (0.3%) of PE (1 fetal, 33.3% of all PE cases) were found in test group. The incidence of DVT, PE (total), and PE (fetal) were significant lower in test group (P < 0.05 or P < 0.01). During the follow up, 14 more cases of DVT (1.4%) and 1 more case (0.1%) of PE (a fetal) were found in the control group, and 2 more DVT cases (0.2%) in test group, with the DVT incidence in test group significantly lower (P < 0.01). (3) During the enoxaparin administration, 30 cases (3.1%) minor bleeding and 8 cases (0.8%) major bleeding were found in the control group, while 33 cases (3.4%) minor bleeding events and 9 cases (0.9%) major bleeding events were found in the test group. THE RESULTS: in the two groups were not significantly different in either type of bleeding events (both P > 0.05). Also no significant difference was found in the bleeding events after the ending of enoxaparin administration and during the follow up. CONCLUSION: Enoxaparin may reduce the incidence of DVT and PE in patients undergoing general surgery without increased risk of bleeding.

[Expression of phosphatase and tensin homolog in lower rectal cancer on neoadjuvant chemoradiotherapy].

OBJECTIVE: To explore the expression of phosphatase and tensin homolog deleted on chromosome ten (PTEN) in low rectal cancer on neoadjuvant chemoradiotherapy with capecitabine plus radiotherapy. METHODS: Sixty-six patients with low rectal cancer on therapy with capecitabine (1650 mg×m(-2)×d(-1) in 2 divided doses) for two course and concurrent radiotherapy (50 Gy, 2 Gy/day, 5 days a week). Then the investigators analyzed the relationship between the preoperative neoadjuvant chemoradiotherapy and prognosis and measured the expression of PTEN during neoadjuvant chemoradiotherapy. RESULTS: 92.4% (61/66) of patients received neoadjuvant chemoradiotherapy as planned. 87.9% (58/66) tumor stages were down-staged, tumor size decreased while the distance from anal edge increased. And curative resection with sphincter-sparing was carried out in all patients. The rate of sphincter preservation was 90.9% (60/66). Among which, 85.5% patients showed an excellent function of sphincter. The 2-year survival rate was 87.9% (58/66). The survival period was an average of 35.3 months (range: 25-60). The PTEN mRNA and protein expression in cancer tissues on neoadjuvant chemoradiotherapy were significantly higher than those before neoadjuvant chemoradiotherapy (P=0.0079, 0.0269). CONCLUSIONS: The preoperative neoadjuvant chemoradiotherapy in lower rectal cancer patients has shown its efficacy in down-staging cancer, enhancing resectability, offering sphincter preservation, up-regulating PTEN expression, promoting the apoptosis of cancer cell and achieving a better survival rate. Thus preoperative neoadjuvant chemoradiotherapy is an effective adjuvant measure.