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Generalized peritonitis in India--the tropical spectrum. 印度的广泛性腹膜炎——热带地区。
Pub Date : 1991-05-01 DOI: 10.1007/BF02470946
L Sharma, S Gupta, A S Soin, S Sikora, V Kapoor

Generalized peritonitis is a common surgical emergency in India, the 'Tropical Spectrum' of generalized peritonitis being different from the western spectrum. A total 155 cases of generalized peritonitis were surgically treated at the All India Institute of Medical Sciences between 1981 and 1987, all patients undergoing peritoneal toilet with drainage after the cause of their peritonitis had been treated. The most common cause of peritonitis was peptic ulcer perforation, with simple closure being associated with a 2 per cent mortality, while typhoid perforation was the second most common cause. The diagnosis was clinical, supported by the operative findings of a terminal ileal perforation while bacteriological, serological and histopathological confirmation was retrospective. Appendicular perforations were less common than in the west but the clinical picture was the same. Tubercular perforations were not uncommon with a previous history of subacute intestinal obstruction and evidence of tuberculosis on chest X-ray suggesting the diagnosis. Ruptured amebic liver abscess was the most common hepatobiliary cause of generalized peritonitis with drainage of the abscess producing good results. The average hospital stay was 15 days with an overall mortality of 8 per cent.

在印度,广泛性腹膜炎是一种常见的外科急诊,广泛性腹膜炎的“热带谱”与西方谱不同。1981年至1987年期间,全印度医学科学研究所共手术治疗了155例广泛性腹膜炎,所有患者在治疗了腹膜炎的病因后都进行了腹膜厕所引流术。腹膜炎最常见的原因是消化性溃疡穿孔,简单的闭合与2%的死亡率有关,而伤寒穿孔是第二常见的原因。该诊断是临床的,支持手术发现的终末回肠穿孔,而细菌学,血清学和组织病理学确认是回顾性的。阑尾穿孔较西方少见,但临床表现相同。结核性穿孔并不罕见,既往有亚急性肠梗阻病史,胸片上有结核的证据,提示诊断。阿米巴肝脓肿破裂是全身性腹膜炎最常见的肝胆原因,脓肿引流效果良好。平均住院时间为15天,总死亡率为8%。
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引用次数: 96
Effects of the oral or intratumoral administration of OK432 on the immuno-reactivities of regional lymph nodes in gastric cancer patients. 口服或瘤内给药OK432对胃癌患者局部淋巴结免疫反应性的影响
Pub Date : 1991-05-01 DOI: 10.1007/BF02470950
E Yanagawa, T Toge, Y Yamaguchi, H Kuninobu, K Kuroi, Y Kegoya, N Baba, T Takayama, Y Sato

The effects of OK432, a streptococcal preparation, administered either orally (PO-OK432) or intratumorally (IT-OK432) on the immuno-reactivities of regional lymph nodes were investigated in gastric cancer patients. Although native lymph node lymphocytes (LNL) from untreated patients did not show any cytotoxicities against K562 and Raji cells, enhanced activities were found in LNL from patients administered OK432. Augmenting effects on the cytotoxicities of LNL by in vitro additional OK432, interleukin 2 or gamma-interferon were remarkable in the patients given IT-OK432. Moreover, the cytotoxicities of peripheral blood lymphocytes were augmented in vitro more strongly in patients given IT-OK432 than in those given PO-OK432. Flow cytometric analysis of LNL revealed a decrease in CD4+ cells by PO-OK432 and an increase in CD8+ cells by IT-OK432. An increase in CD4+2H4+ cells and a decrease in CD4+2H4- cells were observed in the patients given OK432, though CD8+CD11+ cells decreased by PO-OK432 while CD8+CD11+ cells increased by IT-OK432. Thus, it is suggested that LNL reactive to OK432 immunotherapy may differ between PO- and IT-OK432, and that the immunoreactivities of local lymph nodes and systemical immuno-reactivities may be highly potentiated by IT-OK432 rather than PO-OK432.

研究了口服(PO-OK432)或瘤内(IT-OK432)链球菌制剂OK432对胃癌患者局部淋巴结免疫反应性的影响。虽然未经治疗的患者的原生淋巴结淋巴细胞(LNL)对K562和Raji细胞没有任何细胞毒性,但服用OK432的患者的LNL活性增强。体外添加OK432、白细胞介素2或γ -干扰素对LNL细胞毒性的增强作用在给予IT-OK432的患者中是显著的。此外,在体外,与PO-OK432相比,给予IT-OK432的患者外周血淋巴细胞的细胞毒性增强更强烈。流式细胞术分析结果显示,PO-OK432使LNL细胞CD4+细胞减少,IT-OK432使CD8+细胞增加。OK432组CD4+2H4+细胞增加,CD4+2H4-细胞减少,PO-OK432组CD8+CD11+细胞减少,IT-OK432组CD8+CD11+细胞增加。因此,我们认为LNL对OK432免疫治疗的反应在PO-和it -OK432之间可能存在差异,局部淋巴结的免疫反应和全身免疫反应可能被it -OK432而不是PO-OK432高度增强。
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引用次数: 0
Lithium carbonate in the preoperative preparation of Graves' disease. 碳酸锂在Graves病术前准备中的应用。
Pub Date : 1991-05-01 DOI: 10.1007/BF02470949
T Tsunoda, N Mochinaga, T Eto, M Yamaguchi, R Tsuchiya, M Izumi

Lithium carbonate was given in the preoperative preparation of 12 patients with Graves' disease, the reasons for its use being side effects of thionamide in 9 patients, insufficient control by thionamide in 1 and psychic symptoms in 2. Lithium carbonate was often used in combination with other drugs, namely; thionamide in 4 patients, beta-adrenergic blockades in 5, reserpine in 5 and glucocorticoid in 1. This preoperative control significantly decreased the mean serum T2 and T4 levels from 656 +/- 55 ng/dl to 180 +/- 16 ng/dl and from 25.9 +/- 2.1 micrograms/dl to 9.7 +/- 1.5 micrograms/dl, respectively. The only adverse effect of lithium carbonate was pollakisuria observed in one patient. All patients underwent subtotal thyroidectomy uneventfully. It is concluded that the administration of lithium carbonate alone or in combination with other drugs is an effective method of preoperatively controlling hyperthyroidism when conventional antithyroid drugs show adverse effects.

12例Graves病患者术前准备给予碳酸锂,使用原因为硫胺副作用9例,硫胺控制不足1例,精神症状2例。碳酸锂常与其他药物合用,即;硫胺4例,β -肾上腺素能阻滞5例,利血平5例,糖皮质激素1例。术前对照显著降低了平均血清T2和T4水平,分别从656 +/- 55 ng/dl降至180 +/- 16 ng/dl和从25.9 +/- 2.1微克/dl降至9.7 +/- 1.5微克/dl。碳酸锂唯一的不良反应是在一名患者中观察到尿尿。所有患者均顺利行甲状腺次全切除术。结论:术前常规抗甲状腺药物出现不良反应时,碳酸锂单用或联用其他药物是控制甲亢的有效方法。
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引用次数: 6
The relationship between juxtapapillary duodenal diverticula and the presence of bacteria in the bile. 十二指肠乳头旁憩室与胆汁细菌存在的关系。
Pub Date : 1991-05-01 DOI: 10.1007/BF02470948
N Shinagawa, T Fukui, K Mashita, Y Kitano, J Yura

A total of 432 patients with gallstone disease were studied with respect to the existence of juxtapapillary duodenal diverticula and their relationship to the presence of bacteria in the bile. A total of 63 patients were found to have diverticula with an incidence of 14.6 per cent, being significantly higher in the elderly group aged 60 years or older (p less than 0.01), and no sex difference was noted. Among the patients with diverticula, positive bacterial cultures of bile were recognized at a significantly higher frequency, being found in 49 of the 63 patients (77.8 per cent; p less than 0.01), and the probability of bilirubinate stones was also higher, being found in 35 of 37 patients (94.6 per cent; p less than 0.01). The presence of a diverticulum bore significant relation to a higher positive bile bacterial culture (p less than 0.05), dilation of the common bile duct (p less than 0.05), and elevation of the bile duct pressure (p less than 0.05), even when the conditions were divided into cholecystolithiasis or choledocholithiasis. It was suggested that the presence of a diverticulum affected the flow in the bile duct by narrowing it from the outside and chronically stimulating the papilla, inducing biliary tract infection and/or the formation of gallstones. As the surgical procedures for juxtapapillary duodenal diverticula, including its indications, have not been established, long term follow up investigations seem necessary.

本文研究了432例胆结石患者乳头旁十二指肠憩室的存在及其与胆汁中细菌存在的关系。共发现憩室63例,发病率14.6%,60岁及以上年龄组发病率明显高于老年组(p < 0.01),性别差异无统计学意义。在憩室患者中,胆汁细菌培养阳性的频率明显更高,63例患者中有49例(77.8%;P < 0.01),胆红素结石发生率也较高,37例患者中有35例出现胆红素结石(94.6%;P < 0.01)。憩室的存在与较高的胆汁细菌培养阳性(p < 0.05)、胆总管扩张(p < 0.05)和胆管压力升高(p < 0.05)有显著关系,即使当病情分为胆囊结石或胆总管结石时也是如此。提示憩室的存在通过从外部使胆管变窄,慢性刺激乳头,诱导胆道感染和/或胆结石的形成,从而影响胆管的流动。由于十二指肠乳头旁憩室的手术方法及其适应症尚未确定,因此有必要进行长期随访。
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引用次数: 6
The results and problems of extensive radical surgery for carcinoma of the head of the pancreas. 胰头癌广泛根治性手术的结果与问题。
Pub Date : 1991-05-01 DOI: 10.1007/BF02470944
T Nagakawa, I Konishi, K Ueno, T Ohta, T Akiyama, M Kanno, M Kayahara, I Miyazaki

Since 1973, 152 patients with pancreatic carcinoma have undergone surgery in our clinic, including 110 with carcinoma of the head of the pancreas. Of these 110 patients, resections were performed on 43 (39.1 per cent), 33 (30 per cent) of whom underwent a curative resection based on macroscopic evidence. Six of the patients who underwent macroscopic curative resection survived for five years, giving a five-year survival rate of 36.5 per cent by the Kaplan-Meier method after excepting 6 operative deaths. We compared the extent of pancreatic cancer by constructing survival curves according to the General Rules published by the Japan Pancreas Society. There was no statistical difference in survival based on tumor size or stage, however, there was a significant difference in the survival curves of so and se, being the absence or presence of the anterior capsule of the pancreas, rpo and rpe, being the absence or presence of invasion of the retroperitoneal tissue; ew(-) and ew(+) being the absence or presence of invasion at the surgical margin of resection, or n0 and n1 being the extent of lymph node metastasis. The results of this comparison suggest that extended radical pancreatectomy may be indicated for the treatment of pancreatic cancer as the standard radical operation for pancreatic cancer may miss tumors which have spread to the retroperitoneum and extrapancreatic nerve plexus.

自1973年以来,我院共收治胰腺癌患者152例,其中胰头癌110例。在这110例患者中,43例(39.1%)进行了切除,其中33例(30%)根据肉眼证据进行了根治性切除。6例接受肉眼治愈性切除的患者存活了5年,除6例手术死亡外,Kaplan-Meier法的5年生存率为36.5%。我们根据日本胰腺学会发布的一般规则,通过构建生存曲线来比较胰腺癌的程度。肿瘤大小和分期的生存率无统计学差异,但胰腺前囊缺失或存在,rpo和rpe,腹膜后组织浸润缺失或存在,so和se的生存曲线有显著差异;Ew(-)和Ew(+)表示手术切除边缘没有或存在浸润,n0和n1表示淋巴结转移的程度。结果提示胰腺癌的标准根治术可能会遗漏肿瘤扩散至腹膜后及胰外神经丛,因此扩大根治术是治疗胰腺癌的可行方法。
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引用次数: 15
Frank melena in a patient with fallopian tube pregnancy. 弗兰克·梅兰娜,输卵管妊娠患者。
Pub Date : 1991-05-01 DOI: 10.1007/BF02470961
H Iwagaki, M Kitamura, S Fuchimoto, K Hamaya, K Kataoka, K Orita

We present herein a case of a young woman who experienced lower intestinal hemorrhage caused by ischemic necrosis of the small intestine induced by the compression of a Fallopian tube hematoma in an ectopic pregnancy. All accessible preoperative attempts to clear the site of the bleeding were unsuccessful and an exploratory laparotomy was indicated seventeen days after the development of melena. An ileocecal resection and right salpingectomy finally had to be performed.

我们在此提出一个病例的年轻妇女谁经历了下肠出血引起的小肠缺血性坏死的压迫输卵管血肿在异位妊娠。术前所有可行的清除出血部位的尝试均未成功,在黑黑症发生17天后,需要进行剖腹探查。最后进行回盲切除和右侧输卵管切除术。
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引用次数: 0
The influence of stromal cells on the MTT assay (I)--In vitro chemosensitivity of the tumor and stromal cells to mitomycin C. 基质细胞对MTT测定的影响(I)——肿瘤和基质细胞对丝裂霉素C的体外化学敏感性
Pub Date : 1991-05-01 DOI: 10.1007/BF02470951
A Suto

To clarify the influence of stromal cells on the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide assay (MTT assay), a gastric carcinoma cell line (KATO-III) and a human fibroblast cell line (IMR-90) were subjected to a colorimetric assay, in which the chemosensitivity KATO-III was found to be highly sensitive to mitomycin C at 10 micrograms/ml, whereas IMR-90 was insensitive to mitomycin C at the same concentration. When the mixtures of these two cell lines were tested by the assay, a mixture of more than 25 per cent stromal cells reduced the sensitivity of KATO-III to mitomycin C. This suggested that the stromal cells in fresh surgical specimens might reduce the apparent sensitivity of the tumor cells.

为了阐明基质细胞对3-(4,5-二甲基-2-噻唑基)-2,5-二苯基- 2h四唑溴化试验(MTT试验)的影响,对胃癌细胞系(KATO-III)和人成纤维细胞系(IMR-90)进行了比色试验,发现KATO-III的化学敏感性对10微克/毫升丝裂霉素C高度敏感,而IMR-90对相同浓度丝裂霉素C不敏感。当对这两种细胞系的混合物进行检测时,超过25%的基质细胞混合物降低了KATO-III对丝裂霉素c的敏感性,这表明新鲜手术标本中的基质细胞可能降低了肿瘤细胞的表观敏感性。
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引用次数: 0
The clinical value of tissue carcinoembryonic antigen in breast cancer. 组织癌胚抗原在乳腺癌中的临床价值。
Pub Date : 1991-05-01 DOI: 10.1007/BF02470947
S Haga, O Watanabe, T Shimizu, H Imamura, T Iida, M Makita, T Kajiwara

The relationship of tissue carcinoembryonic antigen (CEA) to clinicopathological factors and prognosis was investigated in 168 patients with invasive ductal carcinoma of the breast. Tissue CEA was determined by radioimmunoassay and a level of 5.1 ng/ml or more considered to be positive. Tissue CEA was positive in 31.5 per cent of the patients overall and, of the clinicopathological factors, tumor size and the presence or absence of lymph node involvement were not found to be correlated with tissue CEA. However, the tissue CEA positivity rate was significantly higher in patients who had four or more metastatic lymph nodes (p less than 0.01). Tissue CEA-positive patients showed earlier recurrence than CEA-negative patients (p less than 0.01) and had a poorer outcome (p less than 0.05). Thus, tissue CEA is considered useful as a prognostic index for primary breast cancer patients.

探讨168例乳腺浸润性导管癌组织癌胚抗原(CEA)与临床病理因素及预后的关系。组织CEA用放射免疫法测定,5.1 ng/ml或更高的水平被认为是阳性的。组织CEA在31.5%的患者中呈阳性,在临床病理因素中,肿瘤大小和有无淋巴结累及与组织CEA无关。然而,组织CEA阳性率在有4个及以上转移淋巴结的患者中明显更高(p < 0.01)。组织cea阳性患者复发较cea阴性患者早(p < 0.01),预后较差(p < 0.05)。因此,组织CEA可作为原发性乳腺癌患者的预后指标。
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引用次数: 2
A case of calcifying carcinoma of the stomach with long-term postoperative survival. 胃钙化癌术后长期生存1例。
Pub Date : 1991-05-01 DOI: 10.1007/BF02470956
K Nakano, I Honda, H Majima, S Fujimoto

A 28 year old man suffering from calcifying carcinoma of the stomach underwent a gastrectomy which was histologically classified as being a noncurative resection. As postoperative adjuvant chemotherapy, he received 116 mg of Mitomycin C and 454.8 g of Tegafur as well as 5690 g of ascorbic acid. He showed carcinoma cells histologically at both oral and anal edges of the resected specimen, and peritoneal metastases of tumor cells were also observed, but he nevertheless kept a performance status of 1 until 5 years after surgery. The patient finally died of cachexia 5 years and 6 months after his operation. Among 42 patients with calcifying carcinoma of the stomach reported in the foreign literature and 19 patients reported in Japanese, those patients for whom the postoperative survival time was clearly indicated did not necessarily survive longer than those patients without calcification.

一个28岁的男子患有胃钙化癌接受胃切除术,这是组织学分类为不可治愈的切除。术后辅助化疗,给予丝裂霉素C 116 mg,替加富454.8 g,抗坏血酸5690 g。他在切除标本的口腔和肛门边缘均可见组织学上的癌细胞,并观察到肿瘤细胞在腹膜转移,但他仍然保持1至术后5年的工作状态。患者于术后5年零6个月死于恶病质。在国外文献报道的42例钙化性胃癌患者和日本文献报道的19例患者中,明确指出术后生存时间的患者并不一定比没有钙化的患者生存时间更长。
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引用次数: 0
The clinical and biological significance of the transitional mucosa adjacent to colorectal cancer. 结直肠癌旁移行黏膜的临床及生物学意义。
Pub Date : 1991-05-01 DOI: 10.1007/BF02470943
Q A Wang, H Gao, Y H Wang, Y L Chen

The underlying nature of the transitional mucosa adjacent to colorectal cancer is defined and the evidence for and against the statement that this transitional mucosa involves primary premalignant change presented in this article. An association between mucin histochemical changes at the margins of resection and a poorer clinical outcome of patients has been recognized in patients with colorectal cancer after surgery. The retained transitional mucosa at the margins of resection appears to correlate with tumor recurrence and a poorer survival in patients who have undergone radical resection. It is considered that the transitional mucosa adjacent to colorectal cancer and its presence at the margins of resection may be an important prognostic marker for patients with large bowel cancer following radical resection.

本文定义了结直肠癌旁移行黏膜的基本性质,并提出了支持和反对该移行黏膜涉及原发性癌前病变的证据。在结直肠癌术后患者中,已经认识到切除边缘粘蛋白组织化学变化与患者较差的临床预后之间的关联。切除边缘保留的移行黏膜似乎与肿瘤复发和接受根治性切除的患者较差的生存率有关。认为结直肠癌旁的移行黏膜及其在切除边缘的存在可能是大肠癌根治性切除后患者预后的重要标志。
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引用次数: 4
期刊
The Japanese journal of surgery
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