[Occult blood detector for the upper G-I tract. I. A preliminary application in cancer screening]

The traditional chemical detection of small amount of blood in the stool can not tell whether the original bleeding site is in the upper or lower part of the G-I tract. The occult blood detector, designed by the authors, having a diameter of 8 mm, can easy be swallowed into the stomach with 30 to 50 ml of water. After remaining for 3 minutes in the stomach, it is pulled out by the patient himself and its coloration read to reveal the degree of bleeding. It can be used either by the medical personnel or the patient himself, at home, for the purpose of detecting minute bleeding in the upper G-I tract and for cancer screening in the high risk population. This detector gave a positive rate of 95% in patients with malignancies in the upper gastrointestinal tract. It is highly acceptable for its lack of discomfort during application. In cancer screening, it gave a positive rate of 5% to 10% in 10000 high risk persons. Those positive in this test showed a high incidence of gastric or esophageal cancers as proved by gastroscopy. This detector is being manufactured and sold by the Baiyunshan Pharmaceutical Factory, Guangzhou, Guangdong Province. Other papers concerning this topic are to be published.

[Resection and reconstruction of the carina]

A case of recurrent adenoid cystic carcinoma after right middle lobectomy is reported. A right lower lobectomy with resection of carina was performed as the lesion involved the right main bronchus, the carina and the orifice of right lower lobe. The carina was reconstructed by the anastomosis of right upper lobe bronchus to the left main bronchus. The postoperative course was uneventful. After two months, the stitch granuloma at the site of anastomosis developed and it was satisfactorily managed by local palliative measures. No recurrence has been found during a follow-up of 1.5 years.

Surgery of esophageal carcinoma

The experience of surgical treatment in 1,874 patients with carcinoma of the esophagus seen at the Cancer Institute and Hospital of the Chinese Academy of Medical Sciences, Beijing, People's Republic of China, between 1958 and 1982, is reported. Despite the prevalence of this malignancy in this part of China, only 3% of the patients in this series had stage I disease, while 80% of the patients had either stage III or stage IV disease with extraesophageal tumor invasion and regional or distant metastases. Of the entire series there was an overall resectability rate of 83.9%, being 77.6% between 1958 and 1969 and 89.0% between 1970 and 1982. Among the 1,572 resections of the entire series, there were 66 deaths within 30 days of operation, for a resection mortality rate of 4.2%, being 4.9% between 1958 and 1969 and 3.7% between 1970 and 1982. Anastomotic leakage occurred in 67 cases of the 1,572 resections, for an incidence of 4.3%. Of the 67 cases with anastomotic leaks, 38 recovered after intensive treatment; the remaining 29 died eventually of the complication, giving a death rate of 43.3%. Pathologic studies of the 1,572 specimens showed lymph node metastasis in 46.1% of the cases. It is obvious that practically all the unresectable cases showed more extensive lymph node involvement at operation, although fixation of the tumor with severe invasion to the surrounding organs usually constituted the chief cause of unresectability. The postresection long-term survivals as calculated by the number of resections at 5, 10, and 15 years were 30.2% (390/1293), 22.4% (196/876), and 18.9% (112/594), respectively. Over one-third, or 36.8%, of the 1,874 patients in the present series were treated with a combination therapy of preoperative irradiation and surgery. The results in the group of 408 selective patients and those in the group of 83 randomized patients with midthoracic esophageal carcinomas were gratifying. In the latter group there was a resectability rate of 95.2%, a resection mortality rate of 3.8%, an incidence of intrathoracic anastomotic leakage of 0%, and a 5-year survival rate of 45.5%, as compared to 89.6%, 4.3%, 1.7%, and 25%, respectively, in the control group treated by surgery alone. From these findings it is concluded that preoperative irradiation as an adjunct can promote both the immediate and long-term results of surgery for carcinoma of the esophagus. Recent advances in the surgical treatment of carcinoma of the esophagus may change the pessimistic philosophy for this malignancy.(ABSTRACT TRUNCATED AT 400 WORDS)