Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus.

Thirty-nine patients with potentially resectable cancer of the middle or lower esophagus who had not previously been treated were randomly assigned to receive either immediate operation (n = 20) or operation plus preoperative and postoperative therapy with cisplatin, vindesine, and bleomycin (n = 19). Patients were stratified by tumor size and location and by sex, with no significant differences appearing between the two treatment groups. Median follow-up for both groups was 30 months. The preoperative response rate to chemotherapy was 47%. The postoperative complication rate for patients in the operation-only group was 47%; it was 29% for patients receiving chemotherapy. The overall resectability rates were similar for the two groups. Patients responding to chemotherapy preoperatively had significantly prolonged survival (median greater than 20 months) when compared with either nonresponders (median 6.2 months) or patients receiving only operation (median 8.6 months). A highly significant correlation was noted between a weight loss of less than 10% and response to chemotherapy, which suggested that responses occurred in patients with less advanced disease. We conclude that preoperative and postoperative cisplatin, vindesine, and bleomycin chemotherapy has acceptable toxicity and does not increase the incidence of postoperative complications. The natural history of epidermoid carcinoma of the esophagus is altered and overall survival is prolonged for patients responding to preoperative chemotherapy. Potential responding patients can be identified by the degree of preoperative weight loss.

Evaluation of the Micro-ID, the API 20E and the Rapid 20E for same-day identification of Enterobacteriaceae.

In a comparative study of three methods for same-day identification, the Rapid 20E identified 91.8% of 328 clinically isolated Enterobacteriaceae correctly to species level, 0.3% to genus level, 4.0% as part of a spectrum of identifications, and 4.0% incorrectly. Corresponding data for Micro-ID were 86.6%, 3.7%, 5.8%, 4.0%, and for same-day API 20E values were 72.6%, 7.3%, 13.4%, and 6.7%. Both Rapid 20E and Micro-ID provide accurate identification within four hours; same-day five-hour API 20E was less satisfactory.