Background and purpose:Myelosuppression is the most common dose-limiting toxicity of tumor chemotherapy in which leukocytopenia and neutropenia are the most common conditions. Not only are up-titrations of the doses of chemotherapeutic drugs limited, but also normal process of the chemotherapy is affected. Filgrastim-Recombinant Human Granulocyte Colony-Stimulating Factor (rhG-CSF) has the activity of stimulating the formation of granulocyte colony and promoting the growth, proliferation and differentiation of granulocytes which can be signiifcantly effective on leukocytopenia and neutropenia induced by chemotherapy. In this study, we observed the leukogenic effects, toxic and side effects of low, medium, and high doses of rhG-CSF used prophylactically after chemotherapy in patients with advanced non-small cell lung cancer (NSCLC), to explore a rational application strategy for rhG-CSF..Methods:One hundred and twenty six patients with pathologically proved advanced non-small cell lung cancer (NSCLC) under chemotherapy were digitally randomized to A, B and C groups. Filgrastim was given to patients of the three groups 24h after the end of chemotherapy. The dosages are: Group A (low dose): 300 μg of Filgrastim, s.c., qd × 1 day; Group B (medium dose): 300 μg of Filgrastim, s.c., qd × 2 days; Group C (high dose): 300 μg of Filgrastim, s.c., qd × 3 days. Then the signs and symptoms as well as toxic and side effects of Filgrastim after medication were observed.Results:Prophylactic usage of medium and high dosages of rhG-CSF could maintain WBC count at no less than 4.0×109/L in nearly 60% of patients. In patients with Grade III leukopenia, more days were needed for recovery of white blood cell (WBC) count with the low dose, while signiifcantly (P<0.05) less days were needed with the high dose. In view of the dynamic changes of neutrophil(ANC), additioning of the high dose of rhG-CSF after chemotherapy could increase the average level ofANC, notably shortening the duration of lowANC caused by chemotherapy. The incidence of infections was 4.76% for the 126 patients as a whole, 9.52% for the low dose group, and 4.76% for the middle dose group. The patients could tolerate the slight side effects incurred during treatment with Filgrastim.Conclusion:All of the three doses (low, medium, and high) of prophylactic administration of Filgrastim after chemotherapy can promote recoveries of WBCs and neutrophil granulocytes and reduce opportunities of infections. High doses of rhG-CSF can be faster and safer in increasing WBCs and neutrophil granulocytes.

OBJECTIVETo explore clinical effect of treatment of fractures of the talar neck with hollow compression screw via inner malleolus tomy approach.

METHODSTwelve patients with fractures of the talar neck included 7 males and 5 females with a mean age of 38 years (reaging from 20 to 56 years). According to the Hawkins classification, 8 cases were type II and 4 cases were type II. Twelve patients were treated with hollow compression screw via inner malleolustomy approach.

RESULTSAll the patients were followed up for 1 year to 6 years and 8 months (average 4 years and 5 months), all the fractures were bony union. The mean Hawkins score was excellent in 5 cases, good in 5 cases, fair in 1 case and poor in 1 case.

CONCLUSIONIt is a good method to treat the fractures of the talar neck with hollow compression screw via inner malleolus tomy approach.

Adult ; Bone Screws ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Neck Injuries ; surgery ; therapy ; Pressure ; Treatment Outcome ; Young Adult

BACKGROUNDMultimodal cocktail periarticular injection (MCPI) with a large volume of low concentration local anesthetics, adrenaline, and anti-inflammatory agents such as non-steroidal anti-inflammatory drug or steroids have shown good pain control and improvement in range of motion after surgery. This study compares the efficacy of pain control after total knee arthroplasty, using multimodal cocktail periarticular injection with steroid or without steroid.

METHODSThis is a prospective, double-blinded, randomized and control study. Seventy-two patients with osteoarthritis that met clinical criteria for total knee arthroplasty were recruited into the study, and were randomized to receive either multimodal cocktail periarticular injection with steroid or without steroid. Pain was assessed by visual analogue scale (VAS) at preoperative and postoperative at rest, and during activity. The range of motion was recorded preoperatively and postoperatively. The amount of daily and cumulative morphine consumption were measured by patient-controlled analgesia in the first 72 hours postoperatively. The duration of celecoxib usage was also recorded at the last follow-up.

RESULTSThere were no differences between the non-steroid and steroid groups with regard to VAS at rest and during activity, or range of motion, at any postoperative observation time. The postoperative Knee Society Knee Score in the steroid group improved significantly as compared with that in non-steroid group at the one-month (84.1±13.1 and 65.9±12.1; P < 0.0045), three-month follow-up (90.2±16.3 and 72.5±16.6; P < 0.0027), but after postoperative six-month the Knee Society Knee Score showed no significant difference between the groups. There was no significant difference in consumption of the morphine about daily or total consumption within 72 hours between the two groups. The duration of celecoxib usage in patients in the steroid group was significantly shorter than that in the non-steroid group ((7.2±0.7) compared with (10.5±1.9) weeks; P = 0.012).

CONCLUSIONThe patients who received the steroid injection had faster rehabilitation and less non-steroidal antiinflammatory drugs consumption.

Aged ; Arthroplasty, Replacement, Knee ; methods ; Celecoxib ; Cyclooxygenase 2 Inhibitors ; administration & dosage ; therapeutic use ; Female ; Humans ; Injections, Intra-Articular ; Male ; Pain Measurement ; Pyrazoles ; administration & dosage ; therapeutic use ; Steroids ; administration & dosage ; therapeutic use ; Sulfonamides ; administration & dosage ; therapeutic use

OBJECTIVETo investigate the effect of preoperative radiotherapy as an adjunctive approach on proliferation and apoptosis of cancer cells in rectal cancer.

METHODSEighty patients with (p)TNM stage II or III rectal cancer were enrolled from April 2000 to December 2002. The patients were divided into two groups, which were group received surgical treatment alone (40 cases) and group received preoperative adjuvant radiotherapy with a radiological dose of 40 G( y ) (40 cases). The expression of Ki- 67 protein in rectal cancer was detected immunohistochemically and apoptosis was detected by TUNEL technique.

RESULTSIn radiotherapy group, the tumor volume shrank markedly in 14 cases, partially in 18,slightly in 8 with an overall efficiency rate of 80% .There was significant positive correlation between spontaneous apoptosis and Ki- 69 marker index in cancer tissues before radiotherapy(gamma =0.563P=0.027). The expression of Ki- 67 in rectal cancer tissues was significantly lower after radiotherapy than that before radiotherapy, as well as in the control group(P=0.017 vs. P=0.011).The expression of Ki- 67 in paratumor tissues 2cm from tumor was significantly lower after radiotherapy than that before radiotherapy. Apoptosis index (AI) in rectal cancer tissues was significantly higher after radiotherapy than that before radiotherapy, and that in the control group (P=0.013 vs. P=0.018).

CONCLUSIONRadiotherapy can inhibit proliferation and induce apoptosis of rectal cancer cells. The expression level of Ki- 67 can be considered as a screening index for preoperative radiotherapy.

Apoptosis ; radiation effects ; Cell Proliferation ; radiation effects ; Female ; Humans ; Male ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; pathology ; radiotherapy ; surgery

OBJECTIVETo investigate the incidence of lymph node metastasis (LNM) in early esophageal carcinoma and the techniques of dissection.

METHODSStandard three-field dissection was performed in patients with small superficial esophageal carcinoma detected by endoscopy from 1993 - 2007. The lymph node metastases in different regions were identified by histopathology. The survival rate of the cases was analyzed.

RESULTSA total of 149 patients with early esophageal carcinoma were identified by postoperative pathological examination. The overall lymph node metastasis (LNM) rate was 22.8%, and the degree of LNM was 2.4% in all fields. Most lymph node metastases from upper thoracic esophageal carcinoma were found in cervical and the right upper mediastinal nodes. The LNM from middle thoracic esophageal carcinoma were approximately equal in the cervical, mediastinal, and abdominal lymph nodes, and abdominal lymph node metastasis predominated in lower thoracic esophageal carcinoma. The metastatic rate of LNM adjacent to the right recurrent laryngeaal nerve was the highest (44.1%). Significant differences were shown among the rates of LNM in relation to different macroscopic pattern, depth of invasion and differentiation of tumor (P < 0.01), but not to the longitudinal length of tumor (P > 0.05). The overall 5-year survival rate was 77.9%. It was 87.0% in patients without LNM, and 47.1% in those with LNM.

CONCLUSIONLymph node metastasis in early esophageal carcinoma is in a high frequency. Patients with tumor invasion into the mucosa or lamina propria but without lymph node metastasis may undergo a local operation such as endoscopic mucosectomy and have a good prognosis. Patients with tumor invasion into the muscularis mucosae or submucosa should be treated with radical surgery with three-field lymphadenectomy, especially, to dissect the lymph nodes adjacent to the recurrent laryngeal nerve.

Abdomen ; Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Mediastinum ; Middle Aged ; Mucous Membrane ; pathology ; Neck ; Neoplasm Invasiveness ; Neoplasm Staging ; Survival Rate

OBJECTIVETo investigate the role of the expression of growth hormone receptor (GHR) in the development and progression of human colorectal cancer (CRC).

METHODSThe expression levels of GHR and Ki-67 were detected by immunohistochemistry technique in CRC specimens and normal mucous tissue from 100 patients with CRC. The association between expression of GHR and clinicopathological factors was analyzed.

RESULTSThe expression of GHR was higher in the colorectal cancerous tissue compared to the normal mucous tissue (81% vs. 68%). The expression of GHR was significantly correlated with pathological staging (P=0.047), tumor differentiation (P=0.003) and tumor size (P=0.017). The expression of GHR was significantly associated with the expression of Ki-67 (P< 0.01) as well as tumor proliferation (P< 0.01).

CONCLUSIONThe over-expression of GHR is shown in human colorectal cancer and it also plays an important role in the development of human colorectal cancer. The use of rhGH in clinic should be cautious.

Colorectal Neoplasms ; metabolism ; pathology ; Female ; Gene Expression ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Receptors, Somatotropin ; metabolism

Adolescent ; Adult ; Child ; Debridement ; methods ; Electricity ; Female ; Foreign Bodies ; diagnostic imaging ; surgery ; Humans ; Magnetics ; Male ; Metals ; isolation & purification ; Middle Aged ; Tomography, X-Ray Computed ; Young Adult

BACKGROUNDPre-operative chemotherapy has gained widespread interest while treating advanced gastric cancer in eastern countries. However, there is currently no established standard regimen for gastric cancer. The aim of this research was to explore the value of preoperative chemotherapy with a combination of intravenous and intra-arterial intensified chemotherapy in advanced gastric cancer.

METHODSA total of 56 histologically proven gastric cancer patients, who were considered to be stage II or higher with metastatic lymph nodes and with or without distant metastasis (T2-4, N1-3, and M0-1), were treated with a neoadjuvant chemotherapy. Patients received a combination of intravenous 5-Fu (370 mg/m2) and leucovorin (200 mg/m2) on days 1-5, and intra-arterial etoposide (80 mg/m2) and cisplatin (80 mg/m2) on days 6 and 20. After two cycles of preoperative chemotherapy, patients with resectable tumors underwent laparotomy.

RESULTSAll patients finished two cycles of chemotherapy. The overall response rate was 78.57% (44 cases), of which 7.14% (four cases) clinical complete response. Forty-six patients underwent resection, including 21 initially unresectable diseases. R0 resection rate for prechemotherapy resectable and unresectable diseases was 96.15% (25/26 cases) and 66.67% (20/30 cases), respectively. Pathological complete response was observed in 8.70% of patients. Toxicity was moderate and there were no chemotherapy-related deaths. With a median follow-up of 31 months (range 6-76 months), the 5-year survival rate for the whole group and patients with initially resectable tumors were 21.8% and 42.3%, respectively. The median survival for initially resectable and unresectable patients were 41 months (95%CI, 31.006-50.994) and 18 months (95%CI, 13.399-22.601; P<0.01), respectively.

CONCLUSIONPreliminary results proved that the combined intensive chemotherapy was a safe and promising regimen for pre-operative treatment of advanced gastric cancer.

Adult ; Aged ; Cisplatin ; administration & dosage ; therapeutic use ; Etoposide ; administration & dosage ; therapeutic use ; Female ; Fluorouracil ; administration & dosage ; therapeutic use ; Humans ; Infusions, Intra-Arterial ; Infusions, Intravenous ; Leucovorin ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Neoadjuvant Therapy ; methods ; Retrospective Studies ; Stomach Neoplasms ; drug therapy ; surgery

OBJECTIVETo detect K-ras mutations in rectal carcinoma before and after preoperative radiotherapy, and study genetics effect of radiotherapy in rectal cancer.

METHODSForty patients with rectal cancer in pTNM stage II or III were enrolled. There were 20 males and 20 females. Sixteen tumours were pTNM II stage, 24 pTNM III. All patients received preoperative adjuvant radiotherapy. The treatment time is 4 weeks for 40 Gy in 2.0 Gy fractions and it is usually followed by an interval of 1-2 weeks before the operation. Tumor tissue and normal mucosa 2, 4, 6 cm to tumor were collected from patients before preoperative adjuvant radiotherapy and after operation. The K-ras mutations in codon 12 were investigated using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) in tumors and normal mucosa.

RESULTSThe frequencies of K-ras mutations before preoperative adjuvant radiotherapy in tumor tissue and normal mucosa 2, 4, 6 cm to tumor were 47.5%, 22.5%, 2.5% and 0. The frequencies of K-ras mutations before preoperative adjuvant radiotherapy were higher in tumor tissue than in normal mucosa, and were higher in normal mucosa 2 cm to tumor than 4 cm and 6 cm to tumor. The postoperative frequencies of K-ras mutations in tumor tissue and normal mucosa 2 cm, 4 cm, 6 cm to tumor were 25.0%, 5.0%, 0 and 0. Compared to same locations of control group, the frequency of K-ras mutations in tumor tissue and normal mucosa 2 cm to tumor significantly decreased after radiotherapy.

CONCLUSIONFrequency of K-ras mutations of rectal cancer issue and normal mucosa 2 cm to tumor were significantly higher than other normal rectal mucosa, and decreased significantly after radiotherapy. So radiotherapy can inhibit early events of carcinogenesis of mucosa nearby tumor. It was the potential reason of increased rates of resection and sphincter-saving after radiotherapy.

Adult ; Aged ; DNA Mutational Analysis ; Female ; Genes, ras ; genetics ; Humans ; Male ; Middle Aged ; Mutation ; Polymerase Chain Reaction ; Rectal Neoplasms ; genetics ; pathology ; radiotherapy ; surgery

OBJECTIVETo describe the experience with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support of 100 patients.

METHODSRetrospective analysis of the medical files of 100 patients submitted to the implant of extracorporeal membrane oxygenation system for cardiorespiratory assistance of acute and refractory cardiogenic shock from December 2004 to September 2008. There were 67 males and 33 females, age ranged from 5 d to 76 years with a mean of (28+/-26) years, body mass ranged from 3.8 to 100.0 kg with a mean of (42+/-30) kg. The inter-surface of the ECMO equipment system was completely coated by heparin-coating technique. All patients were applied veno-artery ECMO and activated clotting time was maintained between 120 and 180 s and heparin usage dose was 5 to 20 Uxkg(-1)xh(-1). Mean blood flow was 40 to 220 mlxkg(-1)min(-1) during ECMO assistant period.

RESULTSThe shortest ECMO time was 12 to 504 h with a mean of (119+/-80) h. Sixty-one patients (61.0%) weaned off successfully from ECMO, 55 of them (90.2%) were discharged and 6 died of post-operative complications. Thirty-nine patients could not weaned off from ECMO. Total survival discharge rate was 55.0%. Mean aortic pressure before ECMO in survived patients was significantly higher than that of dead patients (P=0.038). Lactic acid concentration of artery blood before ECMO in survived patients was significantly lower than that of dead patients (P=0.005).

CONCLUSIONSECMO is an effective mechanical assistant therapy method for cardiac and pulmonary failure after cardiac surgery. Earlier usage of ECMO for heart lung failure patient and avoiding the main organs from un-recovery trauma are key success.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Extracorporeal Membrane Oxygenation ; Female ; Heart Failure ; therapy ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Respiratory Insufficiency ; therapy ; Retrospective Studies ; Young Adult