Objective To evaluate pericardial devascularization with splenectomy (PCDV) for the treatment of cirrhotic portal hypertension. Methods From January 1994 to December 2004, 177 patients were treated by PCDS, among them posthepatitic cirrhosis was identified in 170 cases, and alcoholic cirrhosis in 7. One hundred and thirty two patients were operated on electively, 25 prophylactically, and 20 emergently. Results The bleeding control rate was 95% , the overall operative mortality rate was 4. 5%. The main causes of death were upper gastrointestinal bleeding, hepatic failure and intra-abdomimal hemorrhage. The mean follow-up time was 3. 6 years. The 5-year survival rate was 90%. The 5-year recurrent bleeding rate was 5. 1% , The rate of postoperative hepatic encephalopathy was 5. 1%. Conclusions This procedure has the advantage of high successful rate of bleeding control, low complication rate, and long term survival.

Adolescent ; Anemia, Aplastic ; complications ; Humans ; Leukemia, Myeloid, Acute ; etiology ; Male

OBJECTIVEThe prognosis for neuroblastoma in advanced stage is still poor, even under conventional chemotherapy. This study aimed to investigate if very high dose chemotherapy in conjunction with autologous peripheral blood stem cell transplantation and 13-cis-retinoic acid could get excellent results in children with high risk neuroblastoma.

METHODSSix children, aged from 4 to 8 years, with stage IV neuroblastoma were included in the study. The duration of the illness before admission was 1 to 12 months. Primary sites of the diseases were in the abdominal cavity (n = 5) and thoracic cavity (n = 1). All of patients had bone marrow metastasis, and one had multiple bone metastasis and orbital metastasis. All of the patients received very high dose chemotherapy, surgery, local radiation (20-30 Gy), and autologous peripheral blood stem cell transplantation as well as 13-cis retinoic acid. Induction chemotherapy included vincristine 0.67 mg/(m2 x 24 h, x 3), cyclophosphamide 2.1 g/(m2 x 24 h, x 2) and doxorubicin 25 mg/(m2 x 24 h, x 3) for 4 courses. Drugs were given as 24 hour-continuous intravenous infusion. Etopside 200 mg/(m2 x 24 h, x 3) and cisplatin 50 mg/(m2 x 24 h, x 3) were given for 2 courses. Conditioning regimen included carboplatin 400 mg/(m2.d) for 4 days, etoposide 300 mg/(m2.d) for 4 days and melphalan 70 mg/(m2.d) for 3 days. 13-cis retinoic acid 160 mg/(m2.d) started on +59 days for 6 courses, each course including 14 days therapy and 14 days rest.

RESULTSSix patients got a complete response before stem cell transplantation. Their bone marrow metastasis disappeared and so did bone and orbital metastasis. However, marrow suppression due to very high dose chemotherapy occurred in all of the patients, which lasted for 3-4 weeks for peripheral leukocyte recovery. Fever occurred after they finished 1/3 course of chemotherapy. Infection, however, was cured with the use of Fortum and Imipenem, ect. Autologous peripheral blood stem cell transplantation was initiated and successful in all cases. Follow-up studies revealed that all the patients were in CR status 4-18 months after transplant, and the cardiac and liver and renal functions were normal. Meanwhile, bone marrow was recovered or in the process of recovery.

CONCLUSIONThe new strategies focused on very high dose chemotherapy, autologous peripheral blood stem cell transplantation and biological therapy might be a good option for patients with advance neuroblastoma.

Abdominal Neoplasms ; therapy ; Bone Marrow Cells ; metabolism ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Isotretinoin ; therapeutic use ; Male ; Neuroblastoma ; therapy ; Peripheral Blood Stem Cell Transplantation ; Treatment Outcome

OBJECTIVEHuman leukocyte antigen (HLA) haploidentical bone marrow is a potential source of donor to children for its availability. The drawback is deleterious graft versus host disease (GVHD) reaction post transplantation because of the incompatibility of HLA antigen expression between donors and recipients, in which donor T lymphocyte is stimulated to proliferate and differentiate. The methoxy polyethylene glycol (mPEG) is a kind of amphoteric compound without immunogenicity, which was used to modify various proteins covalently and to prepare the versatile blood type. If mPEG modification blocks the activation of T cells in grafts, GVHD reaction probably would become less serious and transplantation might become successful. The aim of this study was to verify the improvement of haploidentical bone marrow transplantation (BMT) in a murine model by using mPEG of certain concentration to modify the grafts.

METHODSMale BALB/c mice were chosen as the donor, and female CB(6)F(1) mice as the recipient. There were three groups of mPEG modification, non-modification and irradiation control, and 20 mice in each group. The modified and non-modified mixture of bone marrow and spleen cells (as T lymphocytes) were transplanted to haploidentical lethally irradiated CB(6)F(1) mice via the tail vein. After the transplant, the hematopoietic recovery, survival rate, acute graft versus host disease (aGVHD) and chromosomal karyotype were analyzed and compared with controls.

RESULTSSeventy-five percent (15/20) of mice survived in the group of mPEG modification, while only 40% (8/20) survived in the group without the modification (chi(2) = 5.01, P = 0.025). And 100% mice died in the group of the irradiation control within 2 weeks. The hematopoietic recovery in the group of mPEG modification was show n to be faster than that in the group without modification (P < 0.05). Histopathological examination of the skin, liver and intestine showed typical signs of aGVHD, but the GVHD grading in the group of modification was less severe. The recipient mice in both groups of transplantation surviving for more than 75 days showed complete donor-type implantation by the chimerism examination.

CONCLUSIONThe modification of grafts by mPEG could alleviate aGVHD and improve the survival rate of mice after the haploidentical bone marrow transplantation.

Animals ; Bone Marrow ; drug effects ; immunology ; Bone Marrow Transplantation ; immunology ; Disease Models, Animal ; Graft Survival ; immunology ; Graft vs Host Disease ; immunology ; prevention & control ; HLA Antigens ; immunology ; Immunosuppressive Agents ; pharmacology ; therapeutic use ; Male ; Mice ; Mice, Inbred BALB C ; Polyethylene Glycols ; pharmacology ; therapeutic use ; T-Lymphocytes ; drug effects ; immunology

OBJECTIVENeuroblastoma is the most common malignant solid tumor in children under 4 years. Amplification of MYCN oncogene is associated with advanced-stage disease, rapid tumor progression, resistance to treatment, and poor outcome. Matirne has the anti-tumor activity. This study was designed to investigate the effects of matrine on LA-N-5 cell line proliferation and MYCN gene mRNA expression.

METHODSNeuroblastoma LA-N-5 cells were treated by 0.25, 0.50, 0.75 or 1.00 mg/mL matrine. MTT was used to measure the levels of the proliferation of LA-N-5 cells cultured with different concentrations of matrine. MYCN gene mRNA expression in LA-N-5 cells was measured using real time RT-PCR with SYBR GREEN I fluorescence.

RESULTSThe proliferation of LA-N-5 cells was obviously inhibited by matrine in a dose- and time- dependent manner. Matrine of 1.00 mg/mL treatment for 72 hrs produced a best effect, with an inhibitory rate of LA-N-5 cell proliferation of 36.3% and an inhibitory rate of MYCN gene mRNA expression of 44.6%.

CONCLUSIONSMatrine may inhibit the growth of neuroblastoma cells and down-regulate MYCN mRNA expression. It may be promising as a new drug for treatment of neuroblastoma.

Alkaloids ; pharmacology ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Humans ; N-Myc Proto-Oncogene Protein ; Neuroblastoma ; drug therapy ; metabolism ; pathology ; Nuclear Proteins ; genetics ; Oncogene Proteins ; genetics ; Quinolizines ; pharmacology ; RNA, Messenger ; analysis

OBJECTIVENeuroblastoma is a highly malignant tumor. Stage IV neuroblastoma has a very poor long-term outcome by conventional chemotherapy and surgery and better therapies are essential. This study aimed to explore the long-term effect of high dose induction chemotherapy combined with autologous peripheral blood stem cell transplantation and 13-cis retinoid acid treatment on stage IV neuroblastoma in children.

METHODSTwenty-eight children with stage IV neuroblastoma, aged 2.1-11.5 years (mean 3.3 +/- 1.9 years), were employed for the study. Primary sites of the tumors included adrenal (n=23), chest (n=3), chest-abdomen (n=1) and sacrum (n=1). Before autologous peripheral blood stem cell transplantation the patients received 6 courses of intensive induction chemotherapy. During chemotherapy the autologous peripheral blood stem cells were harvested and the tumor excision was done. After transplantation the local radiation and 13-cis retinoid acid therapy were administered.

RESULTSAfter 6 courses of induction chemotherapy 13 patients got complete remission (CR), 11 got partial remission (PR), and 4 had no response. The 24 patients who received CR or PR completed the full therapy. A 3.5 +/- 0.7 years follow-up showed that the 4-year event-free survival of the CR and PR patients was 29.2%. The median no-relapse survival time in CR patients was 4.1 +/- 0.7 years but 2.8 +/- 0.5 years in PR patients (t= 3.9, P < 0.01).

CONCLUSIONSHigh dose chemotherapy combined with autologous peripheral stem cell transplantation and 13 cis-retinoid acid treatment can improve the long-term outcome of patients with stage IV neuroblastoma. The patients in CR before transplantation had better outcomes than those in PR.

Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Child ; Child, Preschool ; Combined Modality Therapy ; Female ; Humans ; Male ; Neoplasm Staging ; Neuroblastoma ; pathology ; therapy ; Peripheral Blood Stem Cell Transplantation ; Transplantation, Autologous

This study was aimed to explore the effect of ex vivo chemical modification of graft cells with methoxy polyethylene glycol (mPEG) on graft versus host disease (GVHD) after haploidentical stem cell transplantation in neonatal mice and its influence on activity of the stem cells. The modified and non-modified spleen cells of adult CB6F1 mice were injected into the abdominal cavity of neonatal BALB/c mice with 5x10(6) spleen cells per mouse, and GVHD were measured by spleen index (SI). Furthermore, the modified and non-modified mixture of bone marrow and spleen cells (BMS) were transplanted to haploidentical lethally irradiated adult BALB/c mice via tail vein with 2x10(5) BMS per mouse, and the colony forming units of spleens (CFU-S) were counted on the eighth day after irradiation. The results indicated that SI1 in modification group were lower than that in non-modification group, and SI2 in modification group was <1.3, showing that GVHD in modification group were less severe. The numbers of CFU-S formed in both modification group and non-modification group were not significantly different (p>0.05), indicating that the activity of the stem cells were not affected by mPEG modification. In conclusion, the modification of graft cells with mPEG alleviates GVHD after haploidentical stem cell transplantation in neonatal mice, and do not influence the activity of the stem cells.
Animals ; Female ; Graft vs Host Disease ; prevention & control ; Haploidy ; Hematopoietic Stem Cell Transplantation ; adverse effects ; methods ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Polyethylene Glycols ; therapeutic use

The purpose of this study was to evaluate the safety of cryopreserved and thawed peripheral blood stem cell (PBSC) fractionated return infusions in children. 35 children patients with malignant tumors (13 acute leukaemias, 15 neuroblastomas and 7 malignant lymphomas) received fractionated return infusions of cryopreserved stem cells after undergoing high-dose chemotherapy without or with total body irradiation. The toxicities of 70 return infusions were evaluated. All patients were mobilized by chemotherapy plus recombination human granulocyte colony-stimulating factor (rhG-CSF), and then PBSCs were collected by a separator CS-3000 plus or COBE spectra-4. The grafts were cryopreserved in 10% dimethyl sulfoxide (DMSD) and stored in liquid nitrogen. There were totally 70 PBSC transfusions. The total volume of PBSCs transfused: 190 - 420 ml (265 +/- 73 ml or 13.7 +/- 4.2 ml/kg) with a mean of (4.43 +/- 1.91) x 10(8)/kg of PBSCs, and 0.94 +/- 0.18 g/kg of DMSO. The single dose: 90 - 300 ml (132 +/- 37 ml or 6.6 +/- 5.2 ml/kg) with a mean of 0.68 +/- 0.12 g/kg of DMSO. Symptoms occurring during the infusions were recorded. All patients were monitored for 24 hours after infusion. Pulse, blood pressure, body temperature, and respiratory rate were recorded every 15 minutes. At four hours before and 8 hours after infusion, urinalysis was performed. Serum potassium, sodium, creatinine, total bilirubin, aspartate amino transferase (AST), and alanine amino transferase (ALT) levels were examined within 24 hours before and after the first infusion. The results showed that the toxicities observed included hemoglobinuria in 54 return infusions (77.1%), headache in 28 (40.0%), nausea in 24 (34.3%), vomiting in 17 (24.3%), and abdominal pain in 8 (11.4%). Patients who received a graft > 200 ml tended to have a higher frequency of hemoglobinuria, headache, nausea, vomiting, or abdominal pain (P<0.01), and they disappeared quickly, too. Total bilirubin increased after the first return infusion (P<0.01), and there was a significant correlation between the volume of infusion and the degree of total bilirubin increase (r=0.8977, P<0.01). No renal failure or shock occurred. It is concluded that transient hemoglobinuria, headache, nausea, vomiting, and abdominal pain are common toxicities associated with PBSC autograft, and these toxicities are related with a single volume of PBSCs transfused. Total bilirubin increase is correlated with the volume of infusion. In a word, the toxicity is less frequent and lower severe in children with fractionated infusions of cryopreserved peripheral blood stem cell.
Acute Disease ; Adolescent ; Child ; Child, Preschool ; Cryopreservation ; Female ; Granulocyte Colony-Stimulating Factor ; therapeutic use ; Headache ; etiology ; Hematopoietic Stem Cell Mobilization ; methods ; Hemoglobinuria ; etiology ; Humans ; Leukemia ; therapy ; Lymphoma ; therapy ; Male ; Nausea ; etiology ; Neoplasms ; therapy ; Neuroblastoma ; therapy ; Peripheral Blood Stem Cell Transplantation ; adverse effects ; methods ; Recombinant Proteins

OBJECTIVETo evaluate the effects and the toxicity of the protocol of CDV combined with CiE as pre-operative chemotherapy in childhood stage IV neuroblastoma.

METHODSThe clinical data of 27 children aged from 1.2 to 8 years with neuroblastoma in stage IV was retrospectively studied. The primary sites of the diseases were abdomen (n = 21), posterior mediastinum (n = 4) and pelvic cavity (n = 2). Twenty three patients had bone marrow metastasis. Twelve patients had bone metastasis. All patients were treated with the CDV protocol (cyclophosphamide + doxorubicin + vincristine) for 3 cycles and the CiE protocol (cisplatin + etoposide) for 2 cycles. Neuroblastoma therapeutic response evaluation criterion and common terminology criteria for adverse events of National Cancer Institute were used to evaluate effects and chemotherapy related toxicity.

RESULTSAll patients received the pre-operative chemotherapy. The overall response rate was 82%. After chemotherapy, 24 patients received operations. Total resection of primary tumor was found in 14 patients (58%) and part resection in 10 patients (42%). The most common chemotherapy related toxicity was bone marrow suppression: grade IV suppression of neutrophils (n = 27), reduction in hemoglobin (III grade, n = 7; IV grade, n = 20) and reduction in platelet (III grade, n = 2; IV grade, n = 25). Infection was found in all patients and was controlled with antibiotics. I or II grade lesions of digestive, liver and kidney were found and could be recovered after therapy. Grade I neurotoxicity occurred in 2 patients (7%). The heart function damage was not found in any of patients.

CONCLUSIONSThe protocol of CDV combined with CiE as pre-operative chemotherapy might be effective in children with stage IV neuroblastoma.

Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; adverse effects ; therapeutic use ; Child ; Child, Preschool ; Cisplatin ; administration & dosage ; adverse effects ; Cyclophosphamide ; administration & dosage ; adverse effects ; Dacarbazine ; administration & dosage ; adverse effects ; Etoposide ; administration & dosage ; adverse effects ; Female ; Humans ; Infant ; Male ; Neuroblastoma ; drug therapy ; Retrospective Studies ; Vincristine ; administration & dosage ; adverse effects

OBJECTIVETo investigate the efficacy of laparoscope complete mesocolic excision (CME) for right colon cancer.

METHODSThe clinical data of 49 cases of right colon cancer without metastasis and intestinal obstruction who underwent elective laparoscope CME by the same group of surgeons between October 2009 and June 2011 at the First Hospital of Jilin University were analyzed retrospectively.

RESULTSAmong the 49 cases with CME, the median number of total lymph node retrieved was 22. The positive rate of lymph node in patients with stage III disease was 16.3%. The median operative time of all the cases was 145 min. The mean intraoperative blood loss was 75 ml. The median time to flatus passage and defecation was 3 days and 6 days respectively. The median hospital stay was 12 days. The overall postoperative complication rate was 12.2% (6/49).

CONCLUSIONLaparoscope complete mesocolic excision for right colon cancer is safe and feasible.

Adult ; Aged ; Colectomy ; methods ; Colonic Neoplasms ; surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies