Risk factors for oesophageal squamous dysplasia in adult inhabitants of a high risk region of China

BACKGROUND

Oesophageal squamous cell carcinoma (OSCC) is a common cancer worldwide and has a very high mortality rate. Squamous dysplasia is the precursor lesion for OSCC and it can be seen during routine endoscopy with Lugol's iodine staining. We aimed to examine the risk factors for squamous dysplasia and determine if a risk model could be constructed which would be useful in selecting apparently healthy subjects for endoscopic screening in a high risk population in Linzhou, People's Republic of China.

SUBJECTS AND METHODS

In this cross sectional study, 724 adult volunteers aged 40-65 years were enrolled. All subjects completed a questionnaire regarding potential environmental exposures, received physical and dental examinations, and underwent upper endoscopy with Lugol's iodine staining and biopsy. Subjects were categorised as having or not having histologically proven squamous dysplasia/early cancer. Risk factors for dysplasia were examined using univariate and multivariate logistic regression. The utility of the final multivariate model as a screening tool was assessed using a receiver operating characteristics curve.

RESULTS

We found that 230 of 720 subjects (32%) with complete data had prevalent squamous dysplasia. In the final multivariate model, more household members (odds ratio (OR) 1.12/member (95% confidence interval (CI) 0.99, 1.25)), a family history of cancer (OR 1.57 (95% CI 1.13-2.18)), higher systolic blood pressure OR 1.11/10 mm Hg (95% CI 1.03-1.19)), heating the home without a chimney (OR 2.22 (95% CI 1.27-3.86)), and having lost more but not all of your teeth (OR 1.91 for 12-31 teeth lost (95% CI 1.17-3.15)) were associated with higher odds of having dysplasia. Higher household income (OR 0.96/100 RMB (95% CI 0.91-1.00)) was associated with a lower odds of having dysplasia. Although we found several statistically significant associations, the final model had little ability to accurately predict dysplasia status, with maximum simultaneous sensitivity and specificity values of 57% and 54%, respectively.

CONCLUSIONS

We found that risk factors for dysplasia were similar to those previously identified as risk factors for OSCC in this population. The final model did a poor job of identifying subjects who had squamous dysplasia. Other methods will need to be developed to triage individuals to endoscopy in this high risk population.

Inhibition of multidrug resistance by immunisation with synthetic P-glycoprotein-derived peptides

Overexpression of the membrane glycoprotein (P170) represents the most common multidrug resistance (MDR) mechanism in cancer therapy. Specific auto-antibodies to extracellular loops 1, 2 and 4 of murine P170 were elicited in mice using palmitoylated synthetic peptides reconstituted in liposomes, with or without Lipid A, and resuspended in alum. IgM antibodies were detected 14 days following the first injection and IgG1 became predominant after the third challenge. Animals did not show any auto-immune symptoms or induced toxicity up to 18 months after the immunisation. Previous immunisations of mice using liposomes with MDR1 peptides increases the efficacy of chemotherapy treatments with doxorubicin and vinblastine against P388 R cells with increase of 77% in the survival half time in the immunised group. Sera from the immunised mice were also effective in reducing cellular resistance to vinblastine and doxorubicin in vitro. Taken together, these data suggest that this immunisation approach might have potential clinical applications.

Implementation of a 4-y, high-fiber, high-fruit-and-vegetable, low-fat dietary intervention: results of dietary changes in the Polyp Prevention Trial

BACKGROUND

The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial designed to determine the effects of a high-fiber (4.30 g/MJ), high-fruit-and-vegetable (0.84 servings/MJ), low-fat (20% of energy from fat) diet on the recurrence of adenomatous polyps in the large bowel.

OBJECTIVE

Our goal was to determine whether the PPT intervention plan could effect change in 3 dietary goals and to examine the intervention's effect on the intake of other food groups and nutrients.

DESIGN

Participants with large-bowel adenomatous polyps diagnosed in the past 6 mo were randomly assigned to either the intervention (n = 1037) or the control (n = 1042) group and remained in the trial for 4 y. Three dietary assessment instruments were used to measure dietary change: food-frequency questionnaires (in 100% of the sample), 4-d food records (in a 20% random cohort), and 24-h dietary recalls (in a 10% random sample).

RESULTS

Intervention participants made and sustained significant changes in all PPT goals as measured by the dietary assessment instruments; the control participants' intakes remained essentially the same throughout the trial. The absolute differences between the intervention and control groups over the 4-y period were 9.7% of energy from fat (95% CI: 9.0%, 10.3%), 1.65 g dietary fiber/MJ (95% CI: 1.53, 1.74), and 0.27 servings of fruit and vegetables/MJ (95% CI: 0.25, 0.29). Intervention participants also reported significant changes in the intake of other nutrients and food groups. The intervention group also had significantly higher serum carotenoid concentrations and lower body weights than did the control group.

CONCLUSION

Motivated, free-living individuals, given appropriate support, can make and sustain major dietary changes over a 4-y period.

The influence of antagonist standardization on wear

For differences among materials to be easily detected, low variation in in vitro wear tests is desirable. The working hypothesis of this paper was that antagonists standardized for shape and size and according to materials would show mean values similar to those found in natural, non-standardized cusps, and that standardization would lead to a reduction in mean variation. First, the shapes and sizes of palatal cusps of non-erupted human upper third molars were measured. The cusp cupola was best described by the formula y = 0.001 x2 and was symmetrical around the axis of rotation. Up to 200 microm of the y-axis, this parabola corresponded best to a ball radius of 0.6 mm. Based on this information, standardized antagonists were fabricated from both human enamel and steatite. Wear in the occlusal contact area and the wear of opposing conventional ceramic and fine hybrid composite, respectively, were quantified in a computerized chewing simulator. As a control, natural human enamel cusps were used. Standardization of enamel cusps did not reduce the variation of the resulting wear compared with that of non-standardized enamel antagonists. Furthermore, standardization led to significantly different results both in the antagonists and in the opposing restorative materials. Thus, natural enamel antagonists are preferable for the simulation of wear in the occlusal contact area.

Early experience with extraperitoneal endoscopic radical retropubic prostatectomy

This article reports our early experience using laparoscopic instruments and techniques when performing radical retropubic prostatectomy through an entirely extraperitoneal endoscopic approach. Two patients with localized adenocarcinoma of the prostate underwent endoscopic radical retropubic prostatectomy through an entirely extraperitoneal approach (EERRP). The procedure was evaluated for its efficacy in removing prostate and seminal vesicles and in effecting complete vesicourethral anastomosis. Operative time, blood loss, hospital stay, and pathology were also evaluated. Complete endoscopic removal of the prostate and seminal vesicles was achieved in both patients. Endoscopic reconstruction of the bladder neck with watertight anastamosis was successful in both. Operative time and estimated blood loss improved from 5 h and 45 min and 600 cc, respectively, in patient 1 to 4 h and 400 cc in patient 2. Hospital stay was 2.5 days for both. The early experience for EERRP is encouraging. Further evaluation to standardize technique and determine its efficacy and role in treating prostate cancer is in order.

Direct contact between donor families and recipients: crisis or consolation?

A dramatic growth has been seen in the number of organ procurement organizations, transplant programs, and new initiatives related to solving the organ shortage, as well as in the development of protocols dealing with the logistics of facilitating organ and tissue recovery. Extensive deliberation on critical issues related to the organ donor shortage is evident in professional meetings, publications, and educational endeavors. Little research has been conducted, however, regarding direct contact between donor families and recipients, a highly controversial subject in transplantation and procurement. Should there be contact between donor families and recipients? What format should such contacts take? Who should decide? These are questions that must be considered in the field. This article will explore an organ procurement organization's 5-year experience regarding direct contact between donor families and recipients.

Prevention of events with angiotensin-converting enzyme inhibition (the PEACE study design). Prevention of Events with Angiotensin-Converting Enzyme Inhibition

The Prevention of Events with Angiotensin-Converting Enzyme Inhibition (PEACE) trial is an 8,100 patient, randomized, double-blind, placebo-controlled trial designed to determine the usefulness of angiotensin-converting enzyme (ACE) inhibitors in treating coronary patients with preserved left ventricular ejection fraction. The hypothesis being tested in this trial is that patients with coronary disease and ejection fraction > or =40% who are treated with ACE inhibitors will experience a reduction in the incidence of cardiovascular death, nonfatal myocardial infarction, or a revascularization procedure compared with patients treated with conventional therapy. The design of the PEACE trial is described herein.

Efficient antibody generation using histone H1 subfractions purified from western blots

Linker histones from grapevine were purified by electrophoretic methods (SDS-PAGE and electrotransfer onto a nitrocellulose sheet). Individual linker histones were recovered after nitrocellulose solubilization by acetone. The proteins precipitated after this treatment were used as antigen for subsequent immunizations of mice. Such purified immunogens were injected into mice with dimethyl sulfoxide, as the presence of nitrocellulose-protein complexes in the antigen pellets after the acetone treatment was suspected. The resulting antisera were specific to the injected antigens after only the first immunization and could be used as specific probes in immunohistological studies. Our approach seems more efficient (in using less antigen and obtaining a faster response) than the classical procedure recommended for histones in general (B. D. Stollar and M. Ward, 1970, J. Biol. Chem. 245, 1261-1266) and other methods that use free linker histone as immunogen.

High dose combination radiotherapy for the treatment of localized prostate cancer

PURPOSE

We evaluate the efficacy of high dose combination radiotherapy for the treatment of localized prostate cancer.

MATERIALS AND METHODS

A total of 212 patients with localized prostate cancer (T1-T3) were treated with transperineal radioactive seed implantation followed by 45 Gy. external beam radiation therapy. Patients with Gleason scores of 2-5 were treated with 125iodine at a minimum peripheral dose of 120 Gy., while 103palladium at a minimum peripheral dose of 90 Gy. was used for those with Gleason scores of 7-10. Patients with Gleason 6 diploid tumors were treated with 125iodine and those with aneuploid tumors were treated with 103palladium. Biochemical failure was defined as inability to achieve a prostate specific antigen nadir value of 0.5 ng./ml. or less. No patient was treated with androgen deprivation therapy.

RESULTS

The 212 patients have a minimum of 24 months of followup (mean 33 months). Prostate specific antigen 0.5 ng./ml. or less was reached by 72% of the patients (152 of 212) and positive biopsies were detected in 13.9% (20 of 144). Using life table survivorship analysis the probability of initial biochemical success at 5 years was 91% (95% confidence interval, 83 to 97). The probability of subsequent failure following an initial success was 11% (95% confidence interval, 6 to 20) at 24 months. The complications of combination therapy included proctitis in 21.4% (47 of 212 men), impotence in 38% (38 of 100), urinary retention in 1.5%, incontinence in 2.8%, rectoprostate fistula in 2.4%, rectal wall breakdown in 0.5% and urethral stricture in 0.5%. Six patients (2.8%) required colostomy and urinary diversion.

CONCLUSIONS

Short-term responses to high dose combination radiotherapy for localized prostate cancer are promising. The morbidity is acceptable. Further long-term followup is warranted to assess this treatment.

Extraperitoneal endoscopic pelvic lymph node dissection: a review of 125 patients

PURPOSE

We evaluated the efficacy of a totally extraperitoneal approach to endoscopic pelvic lymph node dissection.

MATERIALS AND METHODS

Extraperitoneal endoscopic pelvic lymphadenectomy was performed in 125 patients with clinically localized prostate cancer. All patients were candidates for brachytherapy, cryotherapy or radical perineal prostatectomy. The first 65 patients underwent lymphadenectomy regardless of local clinical stage, prostate specific antigen (PSA) or tumor grade. The last 60 patients met 2 of 3 selection criteria, consisting of clinical local stage T2b or greater, prostate specific antigen greater than 20 and Gleason score 7 or higher. Patients were evaluated for morbidity and mortality, nodal yield, operative time, conversion rate to transperitoneal laparoscopic or open lymphadenectomy and hospital stay.

RESULTS

Mean operative time was 104 minutes, mean length of stay was 2.1 days and mean nodal yield was 10.2. Of the patients 19.2% had positive nodes, and positive nodal yield increased to 32.9% when selection criteria were used. Of the cases 4% were converted to a transabdominal laparoscopic approach and 2.4% to open lymphadenectomy. Symptomatic lymphoceles required percutaneous drainage in 2.4% of the patients. One patient died of massive pulmonary embolism.

CONCLUSIONS

This study demonstrates that the extraperitoneal endoscopic pelvic lymph node dissection is an effective and relatively safe method of surgically staging prostate cancer. It compares favorably to other methods of surgical staging.

Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy

OBJECTIVES

We report our initial experience using laparoscopic instruments and techniques in the performance of radical retropubic prostatectomy (RRP) through an entirely extraperitoneal endoscopic (EE) approach.

METHODS

A 62-year-old man with a Gleason score of 7 and clinical stage T1c adenocarcinoma of the prostate underwent EERRP. The procedure was evaluated for achievement of removal of the prostate and seminal vesicles and for complete vesicourethral anastomosis. Operative time, blood loss, hospital stay, and pathologic findings were also evaluated.

RESULTS

Complete endoscopic removal of the prostate and seminal vesicles was achieved. Endoscopic reconstruction of the bladder neck with a watertight anastomosis was successful. Operative time was 5 hours and 45 minutes, with an estimated blood loss of 600 cc. Hospital stay was 2.5 days. Final pathologic evaluation was a Gleason score of 7 and Stage T2 disease with negative margins.

CONCLUSIONS

The initial experience for EERRP is encouraging. Further evaluation to refine the technique and determine its efficacy and role in treating prostate cancer is in order.

Hernia repair during endoscopic extraperitoneal lymph node dissection

The objective of this study was to determine whether extraperitoneal lymph node dissection for the staging of prostate cancer and extraperitoneal herniorrhaphy could be performed concomitantly with acceptable operative time and morbidity. Sixty patients underwent endoscopic extraperitoneal lymph node dissection (EEPLND) between 1991 and 1996. Eleven of these had 14 hernias repaired with polypropylene mesh. Endoscopic hernia repair added an average of 15 to 20 minutes to the EEPLND, resulting in an average operative time of 127 minutes (range 90 to 182 minutes). There was no difference in postoperative pain between patients undergoing combined operations and those undergoing EEPLND alone. The mean hospital stay after either procedure was 48 hours. There were no complications in the group undergoing herniorrhaphy. We conclude that extraperitoneal endoscopic hernia repair can be safely performed with EEPLND when necessary.

[The VLAP system (Visual Laser Ablation of the Prostate): comparative study of the contact versus non-contact techniques in a series of 100 cases]

OBJECTIVE

To compare two contact and non-contact techniques using the VLAP system (visual laser ablation of the prostate).

PATIENTS AND METHOD

From January 1994 to April 1995, two groups of 50 patients were included in a randomized prospective study and were treated by the contact and non-contact laser technique, respectively. These patients presented with symptomatic BPH requiring transurethral electroresection. These patients were evaluated according to subjective (AUA score) and objective criteria (maximum flow rate, transrectal and suprapubic ultrasonography). ND:YAG laser energy was delivered by a Medilas 4100 source via a lateral beam fibre. Objective success criteria were an improvement of the AUA score by at least 50% and of the maximum flow rate by at least 50% with a difference of 4 mL/s. The failure criterion was the need to perform complementary electroresection during the first 6 postoperative months.

RESULTS

The mortality was 2% (cardiovascular causes), and the overall morbidity (first postoperative month) was 29%, with 21% of a vesical irritation syndrome, 6% of urinary tract infection and 2% of bladder clots. The global result at 12 months showed a statistically significant postoperative improvement of the subjective and objective parameters studied preoperatively (p = 0.0001). In the contact group, the AUA score, mean maximum flow rate and residual urine, which had preoperative values of 19.1, 9.1 mL/s and 141 mL, respectively, were equal to 2.3, 15.6 mL/s and 45 mL at 12 months. In the non-contact group, the same parameters, which had preoperative values of 17.8, 9.2 mL/s and 87 mL, respectively, were equal to 3.8, 13.3 mL/s and 47 mL at 12 months. The results, evaluated as a function of objective success criteria, showed a 12-month success rate of 68% for the contact method and 61% for the non-contact method. The mean hospital stay was 6 days and the mean duration of bladder catheterization was 5 days with the two techniques. During follow-up, 7% of patients required revision by electroresection, regardless of the technique used.

CONCLUSION

this study demonstrated identical results for the contact and non-contact techniques using the VLAP system.

[Laser-assisted endoscopic resection: a new surgical technique for the treatment of benign prostatic hypertrophy. Preliminary results of a study involving 100 patients]

This study was designed to assess the efficiency of 2 kind of laser prostatectomy devices in the treatment of Benign Prostatic Hyperplasia: a non contact technique versus a contact technique versus a contact one. From January 1994 to September 1994, 100 patients were included in a randomized comparison of 2 laser prostatectomy devices with right angle firing laser fibers: a non contact technique with Urolase fiber (Bard) (50 patients) versus a contact technique with Fibertom fiber (Dornier) (50 patients). The Urolase fiber was used at 60 Watts power setting for 60 seconds and administered to each lobe at 2, 4, 8 and 10 o'clock positions. The Fibertom fiber was used by dragging or the so called "painting" technique at 3 and 6 months with 3 parameters: Madsen symptom scores, peak urinary flow rates and post-void residual urine volumes. Operative morbidity rate was 9%. No difference in morbidity between both fibers. No blood transfusion was required in any case. Statistical analysis of the aforementioned parameters shows a p-value of < 0.001 for all parameters. Comparing the 2 different fibers, there was no statistical difference in outcome for any of these parameters. From this study we conclude that the preliminary results achieved, using the Urolase and the Fibertom fiber, are equivocal and interesting. However, a long term follow-up is necessary to evaluate the definitive efficiency of laser prostatectomy and to determine the optimal procedure.

Lesion characteristics and depressed mood in the stroke data bank study

This study examined the relationship between post-stroke lesion size and location and depressed mood by using data from the multicenter National Stroke Data Bank. For in patients with first-ever cerebral infarction, lesions were characterized by location and size from CT scans. Forty-seven (24%) of the 193 patients studied were depressed. In the complete sample, neither lesion size nor location was associated with depression. However, among patients with comparable small-sized lesions (n = 124), depression was more frequent among those with left hemisphere stroke than those with right hemisphere stroke (31% vs. 16%; P = 0.04). Among patients with larger lesions, brain edema was common and may have obscured lateralized findings. Different biogenic amine neurotransmitter responses to right and left hemisphere brain injury may underlie this mood asymmetry.

Felbamate monotherapy: implications for antiepileptic drug development

We studied the effect of felbamate (FBM) monotherapy on seizure rate in patients with partial and secondarily generalized seizures undergoing presurgical monitoring at a single site. The study design was a double-blind placebo-controlled parallel monotherapy trial. Forty patients whose seizures had not been controlled by standard antiepileptic drugs (AEDs) were randomized. Seizure type was confirmed by video-EEG monitoring. All baseline AEDs were discontinued, and patients were drug-free for 5.3 +/- 2.4 days before randomization to FBM or placebo. After a 4-day titration, seizures were counted for 14 days. Patients receiving FBM had significantly lower seizure rates, whether all randomized patients, patients who survived titration, or study completers were compared. Eight of 19 placebo patients randomized to placebo, as compared with 13 of 21 receiving FBM, completed the 18-day study. Two FBM patients dropped out due to seizures, and 6 dropped out due to side effects, including anxiety, difficulty sleeping, abdominal discomfort, acute psychosis, and orobuccal dyskinesias. Ten placebo patients met the criteria for premature discontinuation owing to seizures, and 1 hd an episode of panic. There was no evidence of hepatic or hematologic toxicity. FBM reduces seizure frequency in patients with localization-related epilepsy.

Rapid and effective western blotting of histones from acid-urea-Triton and sodium dodecyl sulfate polyacrylamide gels: two different approaches depending on the subsequent qualitative or quantitative analysis

An improved method for the electrophoretic transfer of histones from sodium dodecyl sulfate (SDS) and acetic acid-urea-Triton X-100 (AUT) polyacrylamide gels onto nitrocellulose membranes is described. In the case of SDS-gels, it was not essential to equilibrate them before transfer while for the AUT-gels, an equilibration step is essential to prevent the interference of Triton X-100 with the binding of histones to nitrocellulose. Transfer efficiency was different for different histone classes. Two procedures were developed: (1) one suitable for qualitative studies, and (ii) another for quantitative transfer.

The dynamics of metabolic change following seizures as measured by positron emission tomography with fludeoxyglucose F 18

OBJECTIVE

To examine the time course of alterations in glucose metabolism in relation to the interval from the last seizure, focus laterality, seizure frequency, and seizure type.

DESIGN

Metabolic study with the use of positron emission tomography with fludeoxyglucose F 18. Blinded scan evaluation with use of a standard template. Multivariate regression analysis of positron emission tomographic data.

SETTING

National Institutes of Health Clinical Center, Bethesda, Md.

PATIENTS

Thirty-two adults with intractable partial epilepsy and lateralized seizure onset documented by video-electroencephalographic monitoring.

MAIN OUTCOME MEASURE

Normalized metabolic rate for glucose ipsilateral and contralateral to the epileptic focus.

RESULTS

The most dramatic changes occurred in inferior temporal regions; the midtemporal region was affected as well. Effects lasting 48 hours were found after both simple and complex partial seizures. The time course was different for the two types of seizures. The inferior temporal metabolic rate ipsilateral to the focus increased compared with the interictal rate during the 24-hour period following simple partial seizures; a nadir occurred in the second 24 hours. The rate then rose to an intermediate level after 48 hours. The relative to an intermediate level after 48 hours. The relative regional increase in ipsilateral metabolism following complex partial seizures persisted for 48 hours before falling.

CONCLUSION

The brain may take longer than 24 hours after a partial seizure to return to its baseline state.

The secondarily generalized tonic-clonic seizure: a videotape analysis

We studied 120 generalized tonic-clonic seizures (GTCSs) in 47 patients with video-EEG telemetry. GTCSs were preceded by antecedent seizures, including 13 simple partial, 70 complex partial, 17 simple partial leading to complex partial, seven tonic, seven clonic, and one typical absence. We divided GTCSs into the following phases: onset of generalization, pretonic clonic, tonic, tremulousness, and clonic. The mean GTCS duration was 62 seconds. There was a non-significant trend toward longer duration on reduced antiepileptic drug doses. Marked heterogeneity in GTCS phenomenology was present; only 27% of seizures included all five phases. Individual phase duration and clinical expression, including tonic and clonic phases, was highly variable. The clinical phenomena suggest that multiple cortical and subcortical routes of spread may exist. When GTCSs last longer than 2 minutes, intravenous antiepileptic drug treatment should be initiated.

Extraperitoneal endoscopic gasless pelvic lymph node dissection

The insufflated extraperitoneal approach to endoscopic pelvic lymph node dissection has been described as an alternative method of staging carcinoma of the prostate. There are several potential pitfalls in performing this approach, including the use of endoscopic instrumentation, trocars, insufflation equipment, and general anesthesia. In order to overcome potential problems associated with this surgical approach, a totally gasless extraperitoneal approach has been developed. This technique uses standard surgical instruments, does not use carbon dioxide to maintain the operative space, and uses general anesthesia. This procedure is more cost effective, since it uses no special instrumentation except the laprolift and laprofan to maintain the extraperitoneal cavity during lymph node dissection.