[Antireflux procedures at our unit (1990-1999)]

A retrospective analysis was carried out to evaluate the changing attitude of antireflux surgical practice of the authors. Between 1990 and 1994 24 antireflux procedures were performed. Laparoscopic antireflux surgery was introduced in 1995. Since then 41 laparoscopic and 23 open repairs have been performed. Indication for surgery was always based on thorough preoperative examination protocol including functional tests of the esophagus. Each patients had undergone endoscopic and X-ray examinations. The patients are under continuous follow-up surveillance. During the postoperative follow-up studies more than 2/3 of the patients (61 patients) agreed to carry out the functional tests postoperatively.

RESULTS

The demographic data of patients of the two study periods proved to be comparable. The length of history was 10.5 years in the first group, while it was 8.9 years in the second group. In both groups the surgical repair caused significant reflux control confirmed by decrease of reflux index and number of reflux episodes furthermore by increase of resting lower esophageal sphincter pressure. Actually 4 recurrences are known in the first group and 2 in the second group. One of the 4 recurrences observed in the first period was treated by redo surgery. The patients having recurrences in the second period can easily be managed by medical therapy. There was no mortality and severe morbidity during the study periods. Few patients reported mild temporary dysphagia.

CONCLUSIONS

In a given proportion of reflux patients the individually planned and perfectly performed antireflux surgery offers an acceptable definitive treatment option. The availability of endoscopic surgery enhances this trend, which can be seen all over the world. An increase can be seen in the number of procedures: nearly three times more patients were operated on during the second period. The early clinical results of laparoscopic antireflux procedures are good enough. Good long-term results can be expected if we accept and apply the basic technical principles determined during the open surgery era.

3,5-diacetyl-1,4-dihydropyridines: synthesis and MDR reversal in tumor cells

Eleven 4-phenyl-3,5-diacetyl-1,4-dihydropyridines (AcDHPs) [G1-11] substituted at the phenyl ring were synthesized and compared for their cytotoxic activity and multidrug resistance (MDR)-reversing activity in in vitro assay systems. Among them, compound [G7] showed the highest cytotoxic activity against human promyelocytic leukemia HL-60 and human squamous cell carcinoma HSC-2 cells. However, no compounds tested produced radicals at pH 7.4-12.5. The activity of P-glycoprotein (Pgp) responsible for MDR in tumor cells was reduced by compounds [G2, 3, 6, 5, 8, 1, 11], verapamil [VP] and nifedipine [NP]. However, compounds [G4, 7, 10] were hardly active while G9 did not show a MDR reversing effect at 2.0-20.0 micrograms/mL. These data show a relationship between chemical structures and MDR-reversing effect on tumor cells.