Direct, uncorrected, molecule-free analysis of 236U from uranium-bearing particles with NAUTILUS: a new kind of mass spectrometer.

We demonstrate use of the Naval Ultra-Trace Isotope Laboratory's Universal Spectrometer (NAUTILUS) at the U.S. Naval Research Laboratory (NRL) to measure 236U directly from uranium-bearing particles free from molecular isobaric interferences. Particles with 235U enrichments in the range of 0.32% to 3.28% and 236U enrichments from no enrichment to 0.015% provided by the International Atomic Energy Agency (IAEA) were analyzed directly using the NAUTILUS. We report the experimental data here without correcting for molecular hydrides and/or applying any other background subtractions. The results from all samples agreed with the certified values within standard error save for the 236U composition of the IRMM 023, which suffered from a combination of insufficient particle sizes and sub-µmol mol-1 236U concentrations. We were able, however, to directly measure as low as three µmol mol-1 of 236U in individual particles regardless of the 235U concentration. Our results are comparable with Large Geometry Secondary Ion Mass Spectrometry (LG-SIMS) and serve as baseline for a more comprehensive comparison between LG-SIMS and the NAUTILUS in the future. Moreover, we demonstrate the ability of the NAUTILUS to generate raster ion images with the same ease as traditional LG-SIMS instruments. By combining our ability to measure 236U directly with raster ion imaging, we were able to detect a low intensity, small uranium-bearing particle in the presence of high molecular backgrounds for a non-ideal sample. This discovery could lead to more targeted and, therefore, less time intensive particle screening methodologies.

The rates of wear of X3 highly cross-linked polyethylene at five years when coupled with a 36 mm diameter ceramic femoral head in young patients.

Polyethylene wear debris can cause osteolysis and the failure of total hip arthroplasty. We present the five-year wear rates of a highly cross-linked polyethylene (X3) bearing surface when used in conjunction with a 36 mm ceramic femoral head. This was a prospective study of a cohort of 100 THAs in 93 patients. Pain and activity scores were measured pre- and post-operatively. Femoral head penetration was measured at two months, one year, two years and at five years using validated edge-detecting software (PolyWare Auto). At a mean of 5.08 years (3.93 to 6.01), 85 hips in 78 patients were available for study. The mean age of these patients was 59.08 years (42 to 73, the mean age of males (n = 34) was 59.15 years, and females (n = 44) was 59.02 years). All patients had significant improvement in their functional scores (p < 0.001). The steady state two-dimensional linear wear rate was 0.109 mm/year. The steady state volumetric wear rate was 29.61 mm(3)/year. No significant correlation was found between rate of wear and age (p = 0.34), acetabular component size (p = 0.12) or clinical score (p = 0.74). Our study shows low steady state wear rates at five years in X3 highly cross-linked polyethylene in conjunction with a 36 mm ceramic femoral head. The linear wear rate was almost identical to the osteolysis threshold of 0.1 mm/year recommended in the literature.

Epithelial bone marrow cells in patients with advanced esophageal squamous cell carcinoma.

The aim of the current study was to examine epithelial cells in the bone marrow and peripheral blood of patients with various stages of esophageal squamous cell cancer prior to surgical treatment and to analyze the prognostic significance of these carcinoma cells deposits to the stage of the disease and applied surgical therapy. Thirty-two patients (25 men and 7 women), and 5 healthy bone marrow donors serving as controls were studied. Bone marrow samples were evaluated by light microscopy and examined by flow cytofluorometry. Cells were phenotypically analyzed for the antigens CD45- and CD18+ and/or EMA+. Results are presented as the number of cells revealing the investigated phenotype per 10 (5)analyzed cells. CD18 was expressed in the bone marrow cells of 15 of the 32 (47%) patients and EMA in 20/32 (62%), but not in peripheral blood. In 13 of the 32 pts (41%), co-expression of CD18 and EMA was observed. Patients with the proportion of marrow erythroblasts below 15% had higher numbers of CD18+ and EMA+ cells and there was a negative correlation between the number of erythroblasts and EMA+ cells (r=0.54, p=0.01). In patients with esophageal cancer and anemia, the number of EMA+ cells was higher (p=0.05) and the percentage of erythropoietic cells in the bone marrow was lower (p=0.01). In conclusion, flow cytofluorometry using anti-cytokeratin and anti-EMA antibodies may be useful in evaluating microdeposits of esophageal squamous cells in bone marrow. A dysfunctioning erythropoietic system causing anemia can be a first signal for the presence of malignant cell microdeposits in the marrow of patients with esophageal carcinoma.

Even a mild anemia is related to tumor aggressiveness mediated by angiogenic factors.

UNLABELLED: Esophagogastric cancers have high recurrence rates with lymph nodes being a common pattern. Pre-treatment anemia has been reported an independent prognostic factor of treatment failure regardless of treatment strategy, particularly associated with poor locoregional control. A causative relationship between anemia - tumor hypoxia - tumor aggressiveness mediated by angiogenesis up-regulation is advocated, yet remains controversial. AIM: To determine whether and how the pre-treatment anemia is associa-ted with various aspects of disease aggressiveness and to evaluate the possible involvement of angiogenesis mediators. METHODS: In 111 esophagogastric cancer patients we investigated the association of pre-treatment hemoglobin concentration and anemia presence with cancer-related, patients-related features and laboratory parameters including angiogenic factors: vascular endothelial growth factors A and C, interleukin-8 and midkine. Serum levels of angiogenic factors were assessed with immunoenzymatic tests. RESULTS: Histology, disease stage, regional metastasis and dissemination in general, malnutrition and angiogenesis represented by midkine were found to correlate with anemia presence and hemoglobin concentration, while tumor extension, patient's age and sex accounted only for anemia presence. A tendency towards hemoglobin correlation with VEGF-A and Il-8 was also observed. Midkine, tumor histology and malnutrition were found to exert an independent effect on pre-treatment hemoglobin concentration and anemia presence in esophagogastric cancer patients. Hemoglobin level of 12 g/dL was found an optimal cut-off value for discrimination between localized and disseminated cancers. CONCLUSIONS: Even a mild pre-treatment anemia is associated with cancers metastasizing especially to regional lymph nodes, which seems to be mediated by some of studied angiogenic factors.

Expression of decorin in esophageal cancer in relation to the expression of three isoforms of transforming growth factor-beta (TGF-beta1, -beta2, and -beta3) and matrix metalloproteinase-2 activity.

To determine the role of the reactive stroma in cancer progression, we investigated decorin (DCN) and transforming growth factor-beta (TGF-beta expression, and matrix metalloproteinase-2 (MMP-2) activity in the tumorous esophagus. We found statistically insignificantly decreased levels of DCN expression in the pathological tissues. No obvious alterations in TGF-beta expression were noticed. The highly significant increase in MMP-2 activity in cancers did not result in elevated levels of TGF-beta dimers. Therefore, the system of TGF-beta liberation from its complex with DCN by activated MMP-2 does not seem to contribute to esophageal cancerogenesis, although this hypothesis should be reevaluated with a larger study group.

Respiratory insufficiency related to COPD accelerates systemic inflammation, under-nutrition, and angiogenesis in esophageal malignancies.

UNLABELLED: A number of esophageal cancer patients suffer from respiratory insufficiency due to the coexistence of chronic obstructive pulmonary disease (COPD). AIM: To test the hypothesis that COPD-related systemic hypoxemia may result in accelerated inflammation, malnutrition, and angiogenesis in esophageal cancer patients. METHODS: Serum levels of C-reactive protein (CRP), albumin, transferrin, interleukin-1, interleukin-6, interleukin-8, TNF-alpha, platelet-derived growth factor (PDGF-BB), and midkine and patient BMI and weight-loss rate were determined and compared with blood oxygenation status (pO(2), SaO(2)) in 35 esophageal cancer patients and 42 controls. RESULTS: The incidence of cachexia tended to be higher in patients with systemic hypoxemia (67% vs 40%, p = 0.169). Mean SaO(2) level was also significantly decreased in cachectic patients (90.3 vs 93.3%, p = 0.026) and pO(2) exhibited a similar trend (58.0 vs 63.4 mmHg, p = 0.120). Transferrin (234 vs 316 mg/dl, p = 0.005) and albumin (31.9 vs 37.1 mg/dl, p= 0.002) concentrations were reduced and CRP was elevated (129.9 vs 54.7 mg/l, p = 0.004) in hypoxemic patients and correlated with pO(2) (r = 0.47, p = 0.016; r= 0.48, p = 0.012; r = -0.37, p = 0.064) and SaO(2) (r = 0.52, p = 0.006; r = 0.53, p = 0.006; r = -0.40, p= 0.042). Interleukin-6 (9.97 vs 2.21 pg/ml, p = 0.005) and midkine (2101 vs 944 pg/ml, p < 0.001) were elevated and PDGF-BB was decreased (12.2 vs 17.3 pg x 10(-6)/PLT, p = 0.014) in hypoxemic compared with normoxemic patients. Interleukin-6 and midkine negatively correlated with pO(2) (r = -0.44, p = 0.016; r = -0.42, p = 0.011) and SaO(2) (r = -0.54, p = 0.003; r = -0.57, p < 0.0001) and PDGF-BB correlated positively (r = 0.53, p = 0.003; r = 0.44, p = 0.020). Interleukin-8 level was affected by pO(2) (r = -0.55, p = 0.015) and SaO(2) (r= -0.55, p = 0.018) only in hypoxemic patients. CONCLUSIONS: COPD-related systemic hypoxemia negatively affects the status of esophageal cancer patients by accelerating inflammation, under-nutrition, and angiogenesis.

Impact of systemic hypoxemia on cancer aggressiveness and circulating vascular endothelial growth factors A and C in gastroesophageal cancer patients with chronic respiratory insufficiency.

AIM: Due to the common etiologic factor, a considerable number of esophagogastric cancer patients suffer from respiratory insufficiency in course of chronic obstructive pulmonary disease, primary to cancer. Systemic hypoxemia may account for poor oxygenation of tumor tissue-a main driving force of tumor neoangiogenesis. We hypothesized that in cancer patients with respiratory insufficiency, systemic hypoxemia may be related to enhanced aggressiveness of cancer on one side and to the elevation of angiogenic factors on the other. METHODS: The levels of vascular endothelial growth factors A and C were determined with immunoenzymatic methods in patients diagnosed with esophagogastric cancer with or without co-existing respiratory insufficiency in course of chronic obstructive pulmonary disease and in healthy controls. Blood gasometry and hemoglobin levels of cancer patients were related to cancer histology and TNM status, and to circulating vascular endothelial growth factors A and C. RESULTS: Patients with systemic hypoxemia had higher incidence rates of locally advanced tumors. Partial oxygen pressure and blood oxygen saturation were significantly lowered in patients with T4 cancers as compared to less advanced ones. Circulating vascular endothelial growth factor A, but not C, was more elevated in esophagogastric cancer patients with co-existing respiratory insufficiency, as compared to those without respiratory insufficiency. Vascular endothelial growth factor A was also strongly related to the extension of primary tumor. CONCLUSION: Our results show that systemic hypoxemia in esophagogastric cancer patients is associated with the extension of primary tumor and that this effect might be mediated by the up-regulation of circulating vascular endothelial growth factor A.

Serum midkine depends on lymph node involvement and correlates with circulating VEGF-C in oesophageal squamous cell carcinoma.

Lymph node metastasis (LNM) is a key factor for selection of treatment method and patients' prognosis in oesophageal squamous cell carcinoma (ESCC). However, no biomarkers able to support the clinical detection of LNM have been reported. Recently, vascular endothelial growth factor C (VEGF-C) was found to be a more accurate marker of LNM in lung cancer than computed tomography. Midkine is a multifunctional cytokine involved in cancer development. We investigated circulating midkine levels in ESCC patients (n=73) compared with those in healthy subjects (n=42) with double-antibody-sandwich indirect enzyme-linked immunosorbent assay (DASI-ELISA). We found that midkine was elevated in ESCC and involved in metastatic disease. Serum midkine (sMK) was a good marker of LNM, evaluated both clinically and pathologically, as revealed by ROC analysis. It also correlated with serum levels of VEGF-C. The increase of sMK was related to cancer cells, although a weak correlation was observed between sMK and platelet and leucocyte counts.

Serum interleukin-12 and interleukin-18 levels in patients with oesophageal squamous cell carcinoma.

UNLABELLED: Interleukin-12 (IL-12) and interleukin-18 (IL-18) play an important role as immunomodulatory factors in cancer pathogenesis. THE AIM of the study was analyze changes of serum IL-12 and IL-18 concentrations in oesophageal squamous cell carcinoma patients depending on the progression of cancer. MATERIALS AND METHODS: Blood samples were taken from 41 patients with oesophageal cancer: 5 women and 36 men, mean age 59+/-9 years. 23 patients had surgical resection of oesophagus with II and III tumor stage, 18 patients with IV stage of cancer progression were treated by palliative procedures. The control group included 15 healthy blood donors: 4 female and 11 males, mean age 41+/-6 years. The concentrations of IL-12 and IL-18 were determined by ELISA tests. RESULTS: Serum IL-12 and IL-18 amounts detected in blood of oesophageal cancer patients were significantly higher in comparison to control group (p<0.001). Serum IL-12 level was higher in patients with IV stage of the disease than in patients with II and III stages. Also serum IL-18 level was significantly higher in patients with IV stage in comparison to patients surgically treated (p<0.05). Statistically significant differences were found in concentrations of IL-18 according to clinicopathological parameters such as: stage of cancer progression, tumor depth, lymph node metastasis (p<0.05). CONCLUSIONS: Serum IL-12 and IL-18 levels are significantly higher in oesophageal cancer patients than in the healthy subjects. A relation between IL-18 content and cancer progression has been registered.

[Esophageal substitute corrective operations]. / Operacje naprawcze schorzen przelyków wytworzonych z uszypulowanych odcinków jelit.

In the Clinic of Gastrointestinal Surgery at the Medical University in Wroclaw in 402 cases substernal oesophageal reconstruction was performed using different pedunculated oesophageal substitutes. 63 patients had to be operated on for the second time because of disorders in the oesophageal substitute. In 13 cases stenosis in the upper anastomosis and in 3 patients stenosis in the anastomosis with stomach were corrected. In 7 cases oesophageal ulcer was excised. 6 patients were operated because of substitute herniation into pleural cavity. In 3 cases huge diverticula in the neck were removed. 5 patients were operated because of stomach outlet stenosis. In 15 cases operation was necessary to correct the sequel of reflux oesophagitis. In 8 cases the surgery was performed to remove stenosis of the substitute. In 2 cases there was torsion of substitute and in the other 2 cases postoperative stenosis was caused by adhesions. One patient was operated because of the dumping syndrome. In 2 patients with the colon substitute polyps from the segment used for the oesophagus were removed endoscopically. The mortality after corrective surgery on the oesophageal substitute was less than 10% (6/63).

[The second reconstructive operation of the esophagus]. / Ponowne operacje wytwórcze przelyków z uszypulowanych przeszczepów jelitowych.

What we need in order to obtain good results in oesophageal reconstructive surgery is long enough segment of intestine with sufficient blood supply. Evaluation of the blood flow is very difficult and often only after completion of the mobilization and transposition of the intestine into the neck final evaluation can be made. In the cases with poor blood flow one must resign from the already mobilized intestine. In such situation the second operation with the use of different alimentary tract segment must be performed. In our practice we encountered 7 cases where it was necessary to mobilize the second intestinal segment in order to achieve success in the reconstruction of the oesophagus. In 3 cases during the first operation jejunum was used. In 3 cases the necrosis of mobilized jejunal segment forced us to perform the second operation. In two patients during the second operation right colon segment along with terminal ileum was used. The third was operated with the use of right colon. In 2 others right colon was used in the first operation. One of them was operated for the second time with the use of left colon. The other were operated with the use of ileum. 2 patients with the substitute from right colon along with the terminal ileum when operated for the second time had the jejunum and left colon segment used to bridge the gap. Mortality in our reconstructive operations was 28.57% (2/7).

[Iatrogenic esophageal injuries]. / Jatrogenne uszkodzenia przelyku.

Own experience regarding treatment of 25 iatrogenic oesophageal lesion are discussed. Diagnosis was established mainly by x-ray examination with the water soluble contrast and plain chest x-ray. One patient was treated conservatively. 24 were operated. All patients received antibiotics intravenously and for local mouth rinse. Operations consists of chest drainage and exclusion of oesophagus from food passage by gastrostomy. Treatment in all cases resulted in healing of oesophageal lesion.

[Gastroesophageal reflux after reconstruction of the esophagus with colon interposition]. / Refluks zoladkowo-przelykowy po zabiegach wytwórczych przelyku z jelita grubego.

In this study 113 cases were analysed; in which colon interposition was used for the reconstruction od the esophagus. The function od the esophageal grafts was evaluated 2 to 36 years after the reconstruction. Massive reflux was observed mainly when the anastomosis had been made to the gastric fundus. Reflux to isoperistaltic grafts was found in 21% of cases in children and in 27% od cases in adults, whereas for antiperistaltic grafts is was found in 33% od cases in children and in 61% od cases in adults. 4 children and 7 adult patients required a a reoperation.

[Surgical methods of protecting grafts from the colon against gastric reflux]. / Chirurgiczne sposoby zabezpieczenia przeszczepu z jelita grubego przed refluksem tresci zoladkowej.

The authors presented their methods of protecting esophageal grafts made of colon intestine from the gastric reflux to the graft; the methods were invented in their Department and verified in clinical practice. 51 patients had anti-reflux interpositions of jejunal or ileo-cecal segments made during the initial reconstruction or as a reoperation. Despite this, reflux was found on control examination in 12 cases, 8 of which had esophagitis confirmed by histology.

[Pleural hernia of an esophageal graft--late postoperative complication]. / Przepukliny oplucnowe sztucznych przelyków--odlegle powiklania pooperacyjne.

Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed.

[Multiorgan trauma complicated by purulent processes and occlusion of the digestive tract]. / Uraz wielonarzadowy powiklany procesami ropnymi i niedroznoscia przewodu pokarmowego.

Authors presented a case of multiorgan trauma complicated, during a treatment by purulent course and occlusion of digestive tract. They punctuate an important rate of intensive care and postoperative care, which enabled a diagnose of early dangerous complications and effective treatment.

[Benign esophageal tumors]. / Lagodne guzy przelyku.

The authors present seven cases of benign oesophageal tumours treated in hospital in the years 1972-1990. Among the treated patients were six men and one woman, aged from 30 to 70 years. In four patients the tumour was situated in the middle part of the thoracic segment, and in three cases in the lower part of the supradiaphragmatic segment of the oesophagus. The diagnosis od benign oesophageal tumour was made on the basis of X-ray examination, oesophagoscopy, and histopathological examination. Five patients were treated surgically. In two patients the access to the tumour was from the right pleural cavity, and in three other cases--from the abdominal cavity. The result of histopathological examination of the removed tumours was as follows: in two patients--benign polyps, in one patient--mature teratoma, in one female patient--myxofibroma, and in one case--fibromyoma. In all patients operated on complete cure was achieved.

Surgical treatment of cardiospasm and megaoesophagus.

Long-term results of operative treatment of cardiospasm and megaoesophagus in 111 patients are presented. There were 67 women and 44 men treated, age 4 to 65. The authors have for several years used their own, in this Department developed method of operation for cardiospasm, which joins Heller's operation with the reconstruction of the cardia to prevent reflux. In very advanced stages of the disease as megaoesophagus they use an original surgical procedure, which consists in connecting the thoracic segment of the oesophagus with the prepyloric part of the stomach by means of a pedicle jejunal graft. Clinical follow-up supported by x-ray examination and endoscopy has shown very good results of such treatment.

The role of expectancy in hypnotic hypermnesia: a brief communication.

Previous research has yielded equivocal evidence of hypnotic memory enhancement. The present experiment assessed the effects of expectancy and hypnotizability on recall for videotaped material under waking and hypnotic conditions. Ss (N = 138) were informed of hypnotic induction either before (expectancy condition) or after (no expectancy condition) watching a videotaped enactment of a crime and completing an initial waking recall test (RI). Both groups then underwent hypnotic induction, and completed the test again (R2). Ss' raw recall scores were significantly greater under hypnotic than waking conditions, but this hypermnesia was not evident when scores were corrected for mere increase in rate of responding. Ss expecting later hypnosis scored significantly higher than Ss with no such expectations, but again, this difference was not evident in corrected scores. Hypnotizability of Ss was, however, related to corrected recall, with high hypnotizable Ss displaying the greatest increase in rate of responding from R1 to R2. No evidence for the hypothesized "suppression effect" underlying hypnotic hypermnesia was found.

[Late results of esophageal prostheses created from intestinal grafts]. / Pozdní výsledky jícnových protéz ze strevních stepu.

During the last 30 years, 280 retrosternal esophageal replacements from stem intestinal grafts were performed at GIT Surgery Clinic AM in Wroclav. Both clinical and auxiliary investigations showed the small intestine grafts have been of the best function as to the food passage. In esophagi made from the large intestine, the following and mostly frequent changes occur: the dilatations of their lumina, the stop of food passage and inflammatory changes varying in both the degree and extent. Inflammatory changes as well as ulcers are rather difficult to detect by radiology. Through the last years, the Second Clinic of General Surgery AM in Wroclav provides endoscopy of artificial esophagi. Being sophisticated, this approach is of benefit in early determining pathologic changes in the esophageal wall, the collection of contents for biochemical tests, tissue biopsies for histology and the initiation of appropriate therapy.