Abstract:Abstract:Objective:To investigate the effect of simultaneous splenectomy or non-removal of spleen on the survival of patients undergoing radical total gastrectomy for carcinoma of the middle and proximal stomach. Methods:The clinical data of 79 patients with proximal gastric cancer (located in proximal or middle stomach) who underwent radical total gastrectomy between 1994 and 2001 were investigated retrospectively. Of these 79 patients,17 patients (21.5％) underwent splenectomy and 62 patients (78.5％) did not. There were no significant differences in ages,sex,tumor size,tumor location,Borrmann type,histolgic type,histological differentiation, depth of invasion, lymph node metastasis,TNM staging, the number of resected lymph nodes,rate of lymph node metastasis, postoperative complications and recurrence rate between the two groups（P>0.05). Results:The median survival of patients with splenectomy and without splenectomy was (507.4±318.6) days and (849.4±672.9) days,respectively.The patients without splenectomy survived significantly longer than those with splenectomy（P=0.046）.The 1-year,3-year and 5-year survival rates of patients with splenectomy and without splenectomy were 61.18%, 8.23%, 0% and 81.56%, 48.28%, 30.62%, respectively. Multivariate Cox regression analysis indicated that only splenectomy was an independent prognostic factor (P=0.007). Conclusions:The rates of postoperative complications and tumors recurrence were not influenced by splenectomy. Splenectomy did not prolong the survival time of patients with proximal gastric carcinoma who underwent radical total gastrectomy. Preservation of the spleen can prolong postoperative survival time and improve the survival rate in these patients.Splenectomy might only be appropriate for patients with direct invasion of the spleen.

Abstract:Abstract:Objective:To evaluate the value of regional infusion chemotherapy for prevention of local recurrence and hepatic metastasis after radical resection of gastric carcioma.Methods:352 patients with gastric carcinoma undergoing radical operation were preoperatively randomly divided into 2 groups:Regional infusion chemotherapy(treatment group,184 cases) and peripheral venous chemotherapy(control group,168 cases).Results:328 cases(93.2%) were followed-up for 3 to 6 years,and 24 cases were lost to follow up.The 1-,3- and 5-year survival rate was 95.7%,78.3% and 46.3%,respectively,in the treatment group,and 86.8%,48.2% and 22.0%,respectively in the control group.The local recurrence rate and hepatic metastasis rate was 9.2% and 12.5%,respectively,in the treatment group; and was 22.0% and 26.8%,respectively,in the control group.Conclusions:Regional infusion chemotherapy is effective for prevention of local recurrence and hepatic metastasis after radical operation for gastric carcinoma.It is better than peripheral venous chemotherapy and has less toxic side effects.

Abstract:Abstract:Objective:To investigate the relationship between the expression of T lymphoma invasion and metastasis inducing factor 1 (Tiam1), ras-related C3 botulinum toxin substrate 1 (Rac1) with the invasion and metastasis of gastric cancer. Methods: The expressions of Tiam1 and Rac1 proteins in 60 cases of gastric cancer and paracarcioma gastric mucosa tissues were detected using Strept Avidin-Biotin Complex(SABC) immunohistochemical method,and the correlation between the expression of Tiam1, Rac1 and clinicopathological parameters of gastric cancer were analysed. Results: (1)There was negative staining of Tiam1 protein in paracarcioma gastric mucosa tissues, while positive staining was detected in gastric cancer tissues(78.33%)(P< 0.01). (2)The positive staining rate of Rac1 in gastric cancer tissues(71.67%) was significantly higher than that in paracarcioma gastric muscosa(18.33%)(P< 0.01). (3)As the degree of histologic differentiation of gastric cancer decreased, depth of invasion increased, stage of TNM was upgraded or lymph node metastasis appeared, the positive staining rate of Tiam1 and Rac1 proteins in gastric cancer tissues significantly increased(P< 0.05), but there was no obvious correlation between their expression with the sex, age of patient, primary pathological location or size of gastric cancer(P> 0.05). (4) The expression of Rac1 in patients with positive staining of Tiam1 was significantly higher than that in patients with negative staining(P< 0.01). Conclusions:Positive correlation existed between the expression of Tiam1, Rac1 and the infiltration and metastasis of gastric cancer, which suggested that combined examination of Tiam1 and Rac1 in gastric cancer can be helpful to forecast its pathobiological behavior.

Abstract:Abstract:Objective:To identify the expression of PTEN ,vascular endothelial growth factor(VEGF)and matrix metalloproteinase 9(MMP-9) in gastric carcinoma and its relationship to the biological behavior of gastric carcinoma. Methods:The expression of PTEN ,VEGF and MMP-9 in 71 cases of gastric carcinoma tissue and 37 cases of gastric mucosa distant from carcinoma were detected by streptavidin peroxidase immunohistochemistry. Results:The expression of PTEN in gastric carcinoma tissues(71.8%) was significantly lower than its expression in gastric mucosa distant from carcinoma(100%)(P<0.01),and expression of PTEN was inversely correlated with the histologic differentiation of the tumor,depth of tumor infiltration and lymph node metastasis(P<0.05,in all parameters),but was not related to age or sex of the patient(P>0.05).The expression of VEGF in gastric carcinoma(62.5%) was sigificantly higher than in gastric mucosa distant from carcinoma(29.7%)(P<0.01),The expression of VEGF was positively correlated with lymph node metastasis(P<0.01),but was not related to age,sex of the patient,and the degree of histological differentition or depth of tumor infiltration(P>0.05).The expression of MMP-9 in gastric carcinoma(69%) was significantly higer than in gastric mucosa distant form carcinoma(40.5%)(P<0.01) and was positively correlated with lymph node metastasis(P<0.05),but not related to age,sex of the patient,and the degree of histological differentiation or depth of tumor infiltration(P>0.05).The expression of PTEN in gastric carcinoma was inversely correlated with expression of VEGF and MMP-9(P<0.05). Conclusions:Decreased expression of PTEN was found in gastric carcinoma and significantly correlated with histologic differentiation、 depth of infiltration and lymph node metastasis of gastric carcinoma.Also,the expression of PTEN was inversely correlated with the expression of VEGF and MMP-9 in gastric carcinoma. The combined detection of PTEN,VEGF and MMP-9 may be of important clinical value toevaluate the infiltrative ability and prognosis of gastric carcinoma.

Abstract:Abstract:Objective:To analyse the morphological and phenotypic characteristics of dendritic cells obtained by induction of peripheral blood monocytes of gastric cancer patients and provide an experimental basis of dendritic cells for the biological treatment of gastric cancer. Methods:Peripheral blood monocytes of gastric cancer patients were co-cultured with GM-CSF, IL-4 and TNF-α to obtain the dendritic cells. The morphological characteristics of the dendritic cells were observed by light and electron microscopes and the phenotypes were studied by flow cytometry. Results:Mature dendritic cells were oblained seven days after induction culture. These cells showed numerous typical dendritic protuberances on their surface.The phenotypes of the cells increased gradually with their maturation and reached stable levels seven days later. Conclusions:Mature dendritic cells could be obtained from peripheral blood monocytes of gastric cancer patients after induction culture with GM-CSF,IL-4 and TNF-α. The obtained cells had typical morphological and phenotypic characteristics. These cells could be used for further research in the biological treatment of gastric cancer.

Abstract:Abstract:Objective:To apply a fluorescent nucleotide dye Sybr Green I in detecting telomerase activity and assess its clinical value in the diagnosis of colorectal carcinoma. Methods:Telomerase activity was measured by telomeric repeat amplification protocol (TRAP) combined with fluorescent nucleotide dye Sybr Green I in 46 cases of colorectal carcinoma tissue specimens and 19 tumor-adjacent tissue specimens. Results: Telomeric repeat amplification product was displayed as clear bands in PAGE stained with Sybr Green I; the positive rate of telomoerase activity in colorectal carcinoma tissue was 89.13%, whereas no telomerase activity was observed in 19 tumor-adjacent tissue specimens. There was no relationship between telomerase activity and the level of cell differentiation, Dukes stages, or metastasis of lymph nodes. Conclusions: The method of TRAP combined with Sybr Green I to determine telemerase activity is an important method for the diagnosis of colorectal carcinoma.

Abstract:Abstract:Objective:To establish an adriamycin resistant human colon cancer cell line SW480 (SW480/ADM),and study their drug resistance mechanism and reversal.Methods:An ADM-resistant human colon carcinoma cell line SW480/ADM was induced by continuously exposing human colon carcinoma cell line SW480 to gradually increasing doses of Adriamycin(ADM). The multidrug resistance of SW480/ADM was evaluated by MTT assay. The distribution of its cell cycle, the expressions of P-gp, multidrug resistance-associated protein(MRP) and GSH/GST were detected by flow cytometry. ADM content in the SW480/ADM was detected by high-performance liquid chromatography(HPLC). Results:Compared with parental cell line SW480, the SW480/ADM cell line had a slower growth rate and longer doubling time,and distribution of its cell cycle had changed. SW480/ADM was resistant to many anti-tumor agents. IC 50 of ADM of SW480/ADM cells was 13.22 times higher than that of parental cell line SW480, and the expressions of P-gp,MRP and GSH/GST were enhanced significantly(P<0.01). ADM content of the SW480/ADM cells was markedly lower than that of SW480 cells. Conclusions:The resistance of SW480/ADM cells to ADM was acquired and had the characteristic of multidrug resistance,and can be used for the study of drug-resistance, reversal and MDR mechanism of human colon carcinoma.

Abstract:Abstract:Objective:To investigate the effect of HSP70 gene transfection to peripheral blood cytokines in the early phase of sepsis in rats. Methods:A rat model of sepsis was established by cecal ligation and puncture(CLP),and adenovirus-mediated HSP70 gene transfection was performed in the CLP rats. Serum TNF-α，IL-1β，IL-6，IL-10 were measured before and after HSP70 gene transfection. Results:In CLP rats, serum TNF-α increased at 3h and peaked at 6h（t TNF-α=16.506, P<0.01）. Serum IL-1β began to elevate at 6h and reached the peak at 24h(t IL-1β=22.536, P<0.01). Serum IL-6 was significantly higher than control group at 3h, and peaked at 12h(t IL-6=33.977, P<0.01). IL-10 began to increase at 24h, reached its peak at 48h(t IL-10=15.056;P<0.01), and returned to the level of control group at 72h. In HSP70 gene transfection rats, the pro-inflammation cytokine level of TNF-α at 6h,IL-6 at 12h,IL-1β at 24h was inhibited,but anti-inflammation cytokine level of IL-10 at 48h was not inhibited. Conclusions:HSP70 gene transfection might down-regulate the overexpression of pro-inflammatory cytokines in the body, and the expression of anti-inflammation cytokines was not inhibited. These results suggested that tranfection of HSP70 gene can provide protective effects against sepsis. HSP70 gene transfection might be of clinical relevance in the prevention and treatment of sepsis and MODS.

Abstract:Abstract:Objective:To improve the diagnosis and treatment of primary duodenal malignant neoplasms(PDMN).Methods:The clinical data of 19 patients with primary malignant neoplasms of the duodenum were anayzed retrospectively.Results:The clinical manifestations were jaudice in 9 cases, upper abdominal pain in 7 cases, gastrointestinal hemorrhage in 6 cases,abdominal mass in 3 cases,and vomitting in 1 case. Diagnostic procedure and detection rate: The detection rate of PDMN by duodenoscopy was 83.3%(15/18), by hypotonic duodenography was 82.3%(14/17), 77.8%(7/9) by CT, and 1 case by MRI.16 cases underwent surgery with resection rate of 68.8 %(11/16).Pancreaticoduodenectomy was performed in 9 cases, simple tumor resection and regional lymphadenectomy in 1 case,resection of duodenal bulb plus partial gastrectomy in 1 case,and gastroenterostomy or choledochojejunostomy in 5 cases.The radical resection rate was 62.5%(10/16).The postoperative 1-,3-,and 5-year survival rate in radical resection patients was 90.0%(9/10)，40.0%(4/10) and 30.0%(3/10),respectively.In those with gastroenterostomy or choledochojejunostomy, the survival time was 6~15 months. Conclusions:Duodenoscopy and hypotonic duodenography are ideal tools for the diagnosis of all locations of PDMN.Pancreaticoduodenectomy might result in prolonged survival of patients with PDMN.

Abstract:Abstract:Objective:To evaluate the therapeutic effect,prognostic factors and the methods to improve long term survival of liver resection for hepatic metastases of colorectal cancer.Methods: 52 patients operated on for hepatic metastases from colorectal cancer were followed up,and the clinical and pathologic data of 11 cases,who survived more than 5 years,were compared with 41 survivors of less than 5 years after hepatic resection.Results: The 1-,3-and 5-year survival rate was 75.0%,30.8%,and 21.2%,respectively.The important factors affecting prognosis were pathologic type of the primary cancer,number of hepatic metastasis,selection of the methods and timing of surgery,and postoperative treatment(P<0.05).Conclusions:The cruxes to improve long-term therapeutic results are radical resection and intensive postoperative combined therapy.

Abstract:Abstract:Objective:To study the surgical treatment of duodenal invasion by cancer of hepatic flexure of colon. Methods:Clinical data of 15 cases of duodenal invasion by cancer of hepatic flexure of colon were analyzed retrospectively.Results:Invasion of the second or third portion of the duodenum by cancer of the hepatic flexure of colon occurred in 15 cases.The duodenum was adhered to the cancer in 6 cases,seromuscular invasion by the tumor in 5 cases,and duodenocolic fistula in 4 cases. All of the cases received surgical treatment. 8 cases were mucoid adenocarcinomas, 4 were poorly differentiated adenocarcinomas, two were moderately differentiated adenocarcinomas, and one was signet-ring cell carcinoma. One patient died after operation, and the five-year survival rate was 46.7%（7/15）. Conclusions:Duodenum is the first organ easily to be invaded by cancer of hepatic flexare of colon. Radical and en bloc resection of the colonic cancer and involved organs is the best therapeutic method. The key to recovery is correct treatment of the surgical defect of the duodenum.

Abstract:Abstract:Objective:To evaluate the method and outcome of surgical treatment for refractory slow-transit constipation (STC). Methods:Clinicopathologic data of 24 patients with severe STC which underwent colectomy in recent years were retrospectively analyzed. Results:18 of the patients underwent pancolectomy,and 6 underwent subtotal colectomy. All of the 14 STC patients complicated with outlet obstructive constipation(OOC) were corrected preoperatively by related surgery. The curative rate of surgical treatment was 95.8％,with an average of（3±1.9） times of bowel motion per day. The incidence of abdominal distention decreased from 75％ to 12.5％. One patient who underwent ileorectal anastomosis developed recurrent constipation. Conclusions:Colectomy produces satisfactory results in the majority of patients with refractory slow-transit constipation.Patients complicated with OOC should undergo energetic preoperative correction therapy,in order to ensure a satisfactory surgical outcome.

Abstract:Abstract:Objective:To study the clinical features,diagnosis and treatment of Dieulafoy′s disease.Methods:The clinical characteristics,diagnosis,methods of treatment and efficacy of treatment of 19 cases of Dieulafoy′s disease were analyzed retrospectively.Results:All cases presented as abrupt upper gastrointestinal bleeding.12 cases(63.2%) were diagnosed at the first,and 4 cases (21.1%) at the second ecdoscopic examination,and 3 cases(15.8%) were diagnosed at exploratory operation.Hemorrhage stopped successfully after one endoscopic treatment in 14 cases and after 2 endoscopic treatments in 1 case.4 cases were cured by operation(including 1 case with re-bleeding 72 hours after endoscopic treatment).Conclusions:Emergency endosopic examination is the best way to diagnose Dieulafoy′s disease and endoscopic treatment is the method of choice to treat it.If hemorrhage fails to stop after endoscopic treatments,surgical operation should be performed immediately.

Abstract:Abstract:Objective:To investigate the pathogenesis, diagnosis and treatment of gastric volvulus. Methods:The clinical data of 30 patients with gastric volvulus were analyzed retrospectively. Results:17 patients(56.7%) were diagnosed preoperatively,and 13 patients(43.3%) at exploratory laparotomy. 21 cases(70.0%) was diagnosed as organo-axial type, 8 cases(26.7%) as mesenterico-axial type, and 1 case(3.3%) as combined type.3 patients underwent gastric volvulus restoration by endoscopy；27 patients received operation,and all the 30 patients were discharged in good health.All of the cases were followed up for 5 years;one case,treated by endoscopy,recurred,but none of the other cases recurred. Conclusions:Laxity of gastric suspensory ligaments is the main pathogenetic factor of gastric volvulus,but its occurrence is usually caused by multiple factors.The diagnosis depends on the combined analysis of the clinical manifestations and radiographic studies or exploratory laparotomy. Operation is the first choice of treatment.

Abstract:Abstract:Objective:To investigate the causes of intra-abdominal hernia and improve the level of early diagnosis and therapy of intra-abdominal hernia. Methods:A retrospective analysis of the clinical data of 68 cases of intra-abdominal hernia was made. Results:The postoperative confirmed diagnosis was para-occal hernia in 1 patient;herniation of efferent jejunal loop through the space between the afferent jejunal loop and the mesocolon after Billroth II gastrectomy in 6 patients,one of which had bowel necrosis,all of the 6 patients were cured after reduction of the hernia or enterectomy after and enteroanastomsis;internal henia though ruptured pelvic peritoneum after Miles operation in 4 patients;internal hernia though the space between the descending colon and the lateral abdominal wall after colostomy of descending colon in 6 patients;internal hernia caused by adhesion of omentum to the intestinal wall of sigmoidostomy in 1 patient;internal hernia through hiatuses caused by postoperative or post-peritonitis adhesions to the peritoneum,ovaries,urinary bladder,uterus,intestinal wall or between loops of intestine in 50 patients(73.5%),including 3 cases of bowel necrosis.All of those patients were cured after reduction of the hernias,repair of the hiatuses,release of adhesions or enterectomy and enteroanastomosis. Conclusions:Preoperative diagnosis of internal abdominal hernia is difficult.The possibility of internal abdominal hernia should be cansidered in patients with a history of operation,and who complain of frequent abdominal pain or bowel obstruction.Early diagnosis and prompt operation is necessary to prevent the occurrence of bowel strangulation and bowel necrosis.