Prevention of stricture with intraluminal stenting through laparotomy after corrosive esophageal burns.

OBJECTIVE: We sought to present our experience in preventing esophageal stricture formation using modified intraluminal stenting in patients with caustic burns. METHODS: Between April 1976 and June 2005, 33 of 162 patients with corrosive esophageal burns were included in this study. Endoscopy was performed to define the degree of injury in all the patients but one. Among the 33 patients, 31 underwent modified esophageal intraluminal stenting through laparotomy 2-3 weeks after ingestion of corrosive agent and the remaining 2 patients underwent immediately after experiencing esophageal perforation. RESULTS: There was no death in this series. A 1-year-old child had aspiratory pneumonia because of poor compliance. The stent was removed without requiring anesthesia after it had been in situ for 4-6 months in the 33 patients. All the patients had a normal intake of food after removal of the stents, and stricture was not found on barium swallow. However, five patients had esophageal stenosis from 2 to 3 months during follow-up. One of them responded to esophageal bougienage, the remaining four patients required esophageal reconstruction and had a normal diet postoperatively. Twenty-four-hour pH monitoring in five patients showed that there was no gastroesophageal reflux. CONCLUSION: The modified esophageal intraluminal stent is able to prevent the formation of caustic esophageal stricture.

[Diagnosis and surgical treatment of middle lobe disease of lung: report of 163 cases].

OBJECTIVE: To discuss the principle of diagnosis and surgical treatment of middle lobe diseases of right lung. METHODS: We analysed the clinical data and prognosis of 163 patients who suffered from middle lobe diseases of right lung and received surgical treatment. RESULTS: There were 97 men and 66 women in the group with the ratio 1.5:1, whose age arranged from 13 to 74 years. The shortest course was one week, and the longest 25 years. The average course was 30.3 months. 78 of 163 patients with tumors were malignant (47.9%) and 85 benign (52.1%). The number of the patients below 50 years old was 91 and 81.3% of them were benign, which was very markedly higher than that of the patients with malignant tumors (P < 0.01). The number of the patients above 50 years old was 72 and 84.7% were malignant, which was very markedly higher than that of the patients with benign tumors (P < 0.01); 8 of 11 patients (72.7%, 8/11) who suffered from tuberculosis combined with bronchoactesis. One of this group died from respiratory failure after operation, packed accumulation of fluid between lobes happened in seven cases (4.3%). The survival rate of 1, 3, 5 years of malignant patients at stages I, II were 88.4%, 62.8%, 51.2%, for that at stages III, IV were 76.5%, 41.2%, 14.7%. All of the four patients who received vage-resection, their malignant tumors recurred in one year after operation. No benign lesion recurred in 10 years. CONCLUSION: (1) It should be noticed that nearly half of middle lobe disease were malignant, especially to those whose ages were above 50 years old. (2) When the diagnosis is hard to be confirmed, open-thoracic exploration should be performed in order not to delay the treatment or enlarge the range of lung resection. (3) Most of middle lobe tuberculosis may be combined with bronchoactesis. (4) Setting drainage tube may be useful to decrease the risk of interlobe accumulation of fluid. (5) Vage resection is not suitable for carcinoma of middle lobe of lung.

Prevention of stricture development after corrosive esophageal burn with a modified esophageal stent in dogs.

OBJECTIVE: We sought to test the feasibility and technical ease of a newly designed nitinol-based modified esophageal stent and its effects on preventing postcaustic stricture in mongrel dogs and to try to explain the result at the molecular level. METHODS: Twenty-four dogs were included in this controlled study. Stenosis index (wall thickness/intraluminal diameter), pathologic features, hydroxyproline quantities, esophageal compliance, and biomechanics were compared between the injured but unstented and stented dogs. Transforming growth factor beta1, Sma/Mad (Smad)3, and Smad7 mRNA expression and protein levels in esophageal tissue were detected by means of reverse transcriptase-polymerase chain reaction and Western blotting, respectively. RESULTS: The modified esophageal stent was able to be placed and retrieved successfully and conveniently and was not only intact but there was also no macroscopic esophageal mucosal injury after the stent removal 4 months later. In comparison with the injured but unstented group, esophageal compliance, biomechanics, and the stenosis index were significantly better in the stented group. Histopathologic study revealed that collagen bundles were thinner and its orientation tended toward a regular and parallel pattern. Transforming growth factor beta1 and Smad3 mRNA expression and protein levels increased and Smad7 mRNA expression and protein levels decreased significantly in esophageal tissue in the stented group. These variables showed no statistically significant difference 2 months after stent removal. CONCLUSIONS: The modified esophageal stent might be a promising stent in preventing stricture formation after corrosive esophageal burns clinically.

Effects of p73 gene overexpression on apoptosis and chemosensitivity of human lung adenocarcinoma cell line A549.

BACKGROUND & OBJECTIVE: It is important to overcome gene therapy resistance caused by wt-p53 in non-small cell lung cancer (NSCLC) . The p53 family member p73 is a p53 homolog. This study was to observe the apoptosis and chemosensitivity effect of p53-resistant human lung adenocarcinoma cell line A549 following wild-type p73 gene transfection alone or combined with chemotherapeutic agents. METHODS: Plasmids pcDNA3-HA-p53 or pcDNA3-HA-p73alpha were transfected into A549 cells with Dosper. Positive cell clones were selected using G418. The exogenous p53 or p73alpha gene expressions were examined by Western blot. MTT assay was used to analyze the response of transfected cells to cisplatin (DDP) or adriamycin (ADM). The drug-induced apoptosis of transfected cells was measured by flow cytometry, TUNEL technique and DNA fragmentation. The biological behavior change of transfected cells was investigated by colony formation assay. RESULTS: Transfected A549 cells stably overexpressed p53 or p73alpha. Low concentration of chemotherapeutic agents (6.25 micromol/L DDP or 0.25 micromol/L ADM) which had no obvious effects on non-transfected cells, suppressed p73-transfected cell growth significantly; the 50% inhibitory concentration (IC(50)) of DDP for A549 cells decreased from 22.65 micromol/L to 3.75 micromol/L, and the IC(50) of ADM decreased from 4.20 micromol/L to 0.06 micromol/L after p73alpha transfection. p73, but not p53, sensitized A549 cells to DDP and ADM: DDP-induced apoptosis rate was increased from 10.6% to 36.8% (P<0.01), ADM-induced apoptosis rate was increased from 13.0% to 41.1% (P<0.01) after p73 transfection. DDP and ADM significantly suppressed colony formation of p73-transfected cells compared with parental cells (P<0.01). The sensitive enhancement ratios for DDP and ADM were 2.0 and 2.4, respectively. CONCLUSIONS: Exogenous p73 gene enhances the sensitivity of A549 cells to chemotherapeutic agents by inducing apoptosis through p53-independent pathway. p73 gene could be used to treat p53-resistant tumors.

Lung volume reduction surgery allows esophageal tumor resection in selected esophageal carcinoma with severe emphysema.

BACKGROUND: Esophageal carcinoma patients with coexisting severe emphysema are high risk surgical candidates. We hypothesize that simultaneous unilateral lung volume reduction surgery (LVRS) allows us to offer esophageal tumor resection to patients previously considered inoperable. METHODS: Twenty-one patients with esophageal carcinoma were recruited. All patients had severe emphysema with impaired respiratory function and health-related quality of life (HRQL). Esophageal tumor resection with gastroesophagostomy in the thorax and then unilateral LVRS were performed at the same anesthesia. Dyspnea index, exercise capacity, pulmonary function, and HRQL were assessed at baseline and every three months up to one year postoperatively. RESULTS: There was no perioperative death or significant morbidity. Clinical improvements were observed at 3, 6, and 12 months, in terms of dyspnea index, forced expiratory volume in 1 second, residual volume, partial pressure of oxygen, arterial, partial pressure of carbon dioxide, arterial, 6-minute walking distance, dysphagia, and odynophagia (p < 0.01 or p < 0.05). The Karnofsky Performance Status score improved from baseline 36 +/- 3 to 53 +/- 3 at 3 months, 67 +/- 5 at 6 months, and 63 +/- 8 at 12 months (p < 0.01). Significant improvement was seen in all the Short-Form 36-item Health Survey HRQL domains at 3 months (p < 0.01 or p < 0.05). These improvements remained significant for up to 6 months, and for up to 12 months for physical functioning and general health. The Psychosocial Adjustment to Illness Scale score and all the scales were improved after surgery (p < 0.01). CONCLUSIONS: Our study shows that in selected patients with esophageal carcinoma who suffer from severe emphysema, simultaneous unilateral LVRS renders esophageal tumor resection safe and effective. Also, these patients may experience early improvement in pulmonary function and HRQL.

[Analysis of the influence on the prognosis and safety of arginine in patients with severe trauma and burns--a multi-center randomized double blinded, placebo controlled, clinical trail in 86 patients].

OBJECTIVE: To observe the influence on prognosis and possible side-effects of arginine in METHODS: Multi-center clinical trial, randomized double blinded patients with severe trauma and burns. and placebo control methods were employed in the study. Eighty-six patients with severe trauma and burns were randomly divided into control (C, n = 45) and arginine treatment (Arg, n = 41) groups. The patients in Arg group received arginine in dose of 0. 4 g x kg(-1) x d(-1) orally, while those in C group received same dose of placebo (tyrosine) for 7 days. All the patients in both groups were given diet with equal calories and equal nitrogen content. The changes in the wound healing time, hospital stay, and the incidence of side-effects of the medication in both groups of patients were observed and compared before and after the supplementation of arginine. RESULTS: The wound healing time and hospital stay days of severe trauma patient in Arg group (n = 29) were 11. 1+/-2. 8 d and 19+/-6 d, which were all obviously shorter than those in C group (13. 2+/-5. 5 d, 22 +/-6 d, n =33, P <0.05). On the other hand, in severe burn patients there were no significant difference of the wound healing time (20+/-5 d vs 22+/-8 d, n = 12, P > 0. 05) and hospital stay days (28+/-6 d vs 29+/-8 d, n = 12, P >0. 05) between the Arg and C groups. In addition, in C and Arg groups, the occurrence of the side-effects were seldom (2. 44% vs 2. 22% , P = 1. 000) and it disappeared when the supplementation of drugs was stopped. CONCLUSION: Oral feeding of arginine is beneficial in enhancing wound healing, reduction of hospital stay days in severe trauma patients and with little side-effects, but it is not beneficial to improve the prognosis of severe burn patients. Maybe this is due to inadequate number of case involved in the study.

[Effect of p73 gene on chemosensitivity of human lung adenocarcinoma cells H1299].

BACKGROUND & OBJECTIVE: Recent studies have shown that wild-type p53 gene can enhance the chemosensitivity of the majority of non-small cell lung cancers. p73 gene and its homologue p53 gene have significant sequence and functional similarities. This study was designed to investigate the effect of p73 gene on chemosensitivity of human lung adenocarcinoma cells H1299. METHODS: The pcDNA3-HA-p73alpha plasmid were transferred into in vitro cultured human lung adenocarcinoma cell line H1299 with Dosper. The p73alpha positive cells which were resistant to G418 were selected out. The expression of exogenous P73alpha protein were examined by Western blot analysis. MTT assay were used to analyze the response of transfected cells to cisplatin (cDDP),adriamycin (ADM). The drug-induced apoptosis of transfected cells was measured by flow cytometry and TUNEL technique. The biological behavior changes of the cells were observed by colony formation assay. RESULTS: The transfected lung adenocarcinoma cell line H1299 overexpressed P73alpha protein stably. MTT assay showed that the IC(50) values for cDDP and ADM were reduced to approximate 86.2% and 99.2% in the transfected cells compared with the untransfected cells, respectively. The low concentration of chemotherapeutic drugs (1.25 micromol/L cDDP or 0.05 micromol/L ADM) without inhibition essentially suppressed the growth of the transfected cells markedly. The cDDP-induced apoptosis rate increased from 10.1% to 38.4%(P< 0.01). The ADM-induced apoptosis rate increased from 12.1% to 49.3%(P< 0.01). Colony-formation assays showed that the colony number in transfected cells was decreased significantly by chemotherapeutic drugs compared with parental cells(P< 0.01). The sensitive enhancement ratios for cDDP or ADM were 1.8 and 2.6, respectively. CONCLUSION: p73 gene was capable of enhancing the sensitivity of H1299 cells to chemotherapeutic drugs such as cDDP and ADM, and the increased sensitivity was associated with the induction of apoptosis undepend p53 gene. It suggests the possibility of using p73 gene combined with anticancer agents to improve the effectiveness of chemotherapy.