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THE EFFECT OF GASTROINTESTINAL TRACT ISCHEMIA ON THE DEVELOPMENT OF MULTIPLE ORGAN DYSFUNCTION SYNDROME

Lianyang ZHANG ; Zhengguo WANG ; Peifang ZHU

Chinese Journal of Bases and Clinics in General Surgery.2001;8(3):200-201,封四.

Objective　To make clear the effect of gastrointestinal tract ischemia on multiple organ dysfunction syndrome (MODS). Methods　The literature in the recent years was reviewed. Results　The low-flow states of gastrointestinal tract and decrease of gastrointestinal intramucosal pH, which occured following a variety of insults (sever trauma, hemorrhagic shock, et al), as well as overgrowth of enterobacteria, may result in a significant increase of permeability of bowel and lead to endotoxemia and bacterial translocation. Ischemia also resulted in release of TNF, IL-6 into the systemic circulation, dysfunction of gastrointestinal tract motility, and activation of neutrophile which was integral in local and distant organ damage. Conclusion　These data suggest that the management of correct ischemia of gastrointestinal tract, which include fluid infusion to replacement of blood volume, early enteral nutrition, improvement of gastrointestinal movement, could contribute to improve the intestinal barrier function, and prevent the development of MODS.

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PLICATION OF SMALL INTESTINE FOR RECURRENT SMALL BOWEL OBSTRUCTION DUE TO ADHESIONS

Jianmin HU

Chinese Journal of Bases and Clinics in General Surgery.2001;8(3):208-封四.

Objective　To array the small intestine so that the uncontrollable adhesions will turn to controllable abhesions in order to prevent the intestinal obstruction. Methods　Literatures were reviewed. The advance of plication of small intestine has passed through three stages: 1st, sewing the intestine just like the array of harpsichord keys; then, using straight needle with coarse threads to make a 'U' suture for the mesentery of small intestine so the intestine was arrayed, and 3rd inserting a Millers-Abbott tube into the lumen of small intestine followed by manual arrangement of the intestine. Results　Using the Millers-Abbott tube the intestine was fixed in a steady position and arrayed in a half moon circular shape to avoid sharp angle. As a result, the intra-luminal pressure of the intestinal was effectively decreased. Follow up 45 cases showed the cure rate of 91.9%. Conclusion　This operation has widely been accepted by the surgeons for its simplicity, high efficacy and reliability. It reduces the recurrence rate of adhesive obstruction.

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CELL APOPTOSIS AND VASCULAR DISEASE

Zhengrong QIAO ; De SHI

Chinese Journal of Bases and Clinics in General Surgery.2001;8(3):202-204.

Objective　To study the relationship between cell apoptosis and vascular disease.Methods　The paper reviewed the concept, character, gene control and signal transduction of apoptosis associated with vascular disease.Results　Cytokine, radiation could induce apoptosis of endothelial cells, and caused vascular damage.The apoptosis of smooth muscle cells was related to the atherosclerosis and restenosis of vessels.Conclusion　Cells apoptosis is related to vascular disease significantly.

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VASCULAR ENDOTHELIAL GROWTH FACTOR AND TUMOR ANGIOGENESIS

Yijun YANG ; Jingsen SHI

Chinese Journal of Bases and Clinics in General Surgery.2001;8(3):205-207.

Objective　To evaluate the effect of vascular endothelial growth factor (VEGF) on tumor angiogenesis, and its usage in tumor therapy. Methods　The recent literatures about VEGF and angiogenesis were reviewed and analyzed. The advances of VEGF study were summarized. The effects of anti-angiogenesis in tumor biological therapy were introduced.Results　Angiogenesis had been identified as an important factor for promoting tumor growth. VEGF was a basic and pivotal factor in tumor angiogenesis. The anti-angiogenesis treatments aimed at VEGF, including the applications of VEGF inhibitor and gene therapy of adenovirus medium, had got great progress. Conclusion　 VEGF is a leading factor of tumor angiogenesis, the anti-angiogenesis therapy aimed at VEGF has probably provided a new chance to malignant tumor treatment.

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THE RESEARCH ON THE RECOMBINANT ADENO-ASSOCIATED VIRUS AS A VECTOR FOR THE GENE THERAPY OF LIVER CANCER

Ziming LIU ; Lünan YAN ; Zhong WANG

Chinese Journal of Bases and Clinics in General Surgery.2001;8(3):133-134.

Objective　 To explore the feasibility of recombinant adeno-associated virus (rAAV) as a vector for the gene therapy of liver cancer. Methods　 The rAAV/enhance green fluorescein protein (EGFP) recombinant was prepared by the routine method of two plasmids cotransfection. Results　 The experiment showed that one 10cm plate could produce 107-108 infection unit recombinant by the method of two plasmids cotransfection, and the transduction of HepG2 cell was increased with the increase of infection dosage of rAAV. About 100 multiplicity of infection (MOI) AAV vector could make all the tumor cell light. Conclusion　 Liver cancer cell can be efficiently transduced by rAAV, and AAV vector may be a valuable vector for the gene therapy of liver cancer.

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EXPRESSION AND SIGNIFICANCE OF SIALYL-LeX IN COLORECTAL CARCINOMA

Peizhong SHANG ; Huaping GU ; Yinchen SUN

Chinese Journal of Bases and Clinics in General Surgery.2001;8(3):151-153.

Objective　To investigate the level of cell adhesion molecule sialyl-LeX expression in colorectal carcinoma and its relation with carcinogenesis, differentiation, metastasis and prognosis. Methods　Sialyl-LeX expression and its optical density in colorectal carcinoma (n=90) and remote normal mucosa (n=30) were quantitatively studied with microwave-LSAB immunohistochemical method combined with image analysis technique. Fifty-three patients were followed up. Results　 The weaker staining in remote normal colorectal mucosa was observed in very limited parts of some deep crypts. Positive rate of sialyl-LeX expression was only 16.7%(5/30). The positive expression of sialyl-LeX was observed in 83 of 90 patients with colorectal carcinoma(92.2%). The apical cytoplasma of cancer tubules, the luminal contents, and the cytoplasma of the cancer cells were strongly stained. The mean integral optical density of sialyl-LeX positive cell in poorly differentiated adenocarcinoma was significantly higher than that in highly differentiated and mucinous ones (P<0.01). It was markedly higher in patients with positive lymphatic nodes than that in negative ones (P<0.01). With followed-up for longer than 5 years, it was much lower in the alive cases than that in the dead (P<0.01). Conclusion　These findings indicate that changes of sialyl-LeX expression and its optical density is related to carcinogenesis, differentiation, invasion and metastasis of colorectal carcinoma. It may be a good predicter for the prognosis of patients with colorectal carcinoma.

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THE CLINICAL FEATURES AND DISCUSSION OF SURGICAL OPERATION FOR DUODENAL TRAUMA

Peng CAO

Chinese Journal of Bases and Clinics in General Surgery.2001;8(3):156-158.

Objective　To study the clinical features of duodenal trauma and its surgery to improve the level of diagnosis and treatment. Methods　Methods of diagnosis and results of surgical treatment were analysed retrospectively of 35 cases of duodenal trauma. Results　The positive rates of abdominal X-ray and abdominal puncture were 32.0%, 13.3% respectively. The extraperitoneal duodenal injuries occured in 30(85.7%) cases. 25(71.4%) cases were complicated by additional intraabdominal organ injuries. The rate of failure to diagnose intraoperatively was 11.4%. The postoperative complication rate was 37.1% and the death rate was 11.4%. Conclusion　Duodenal trauma is characteristic of low diagnostic rate preoperatively, high failure rate intraoperatively and most of the cases are complicated by other intraabdominal organ injuries, so both the complication and mortality are high. If the diagnosis is certain, surgery should been taken suitably. This is the key to improve prognosis. The procedure performed is based on the condition of duodenal injuries.

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EFFECT OF INDUCING DIFFERENATION OF ALL TRANS RETINOIC ACID ON IMMUNITY OF PATIENTS WITH GASTRIC CARCINOMA

Chengliang HUANG ; Houdong LIU

Chinese Journal of Bases and Clinics in General Surgery.2001;8(3):166-168.

Objective　To evaluate the effect of inducing differenation of all trans retinoic acid (ATRA) on immunologic function of patients with gastric cancer. Methods　T-lymphocyte subsets(T-Ls) and interleukin-2 receptor(sIL-2R) of 56 patients with gastric cancer after treatment of ATRA were studied. Results　In radical gastric cancer resection group, the serum CD3,CD4 and CD4/CD8 rate were higher and sIL-2R were lower than those in the control group, after treatment of ATRA, CD3,CD4 and CD4/CD8 rate and sIL-2R were as high as those in the control group. In the non-operative or palliative gastric resection group, CD3,CD4 and CD4/CD8 rates were increased markedly and the serum sIL-2R was decreased significantly than those in the control group. Conclusion　ATRA inducing differenation can improve the immunity of the patients with gastric cancer.

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JUXTAPAPILLARY DUODENAL DIVERTICULA AND BILIARY DISEASES (REPORT OF 18 CASES)

Nansheng CHENG ; Xianze XIONG ; Qifang PENG

Chinese Journal of Bases and Clinics in General Surgery.2001;8(3):173-175.

Objective　To study the clinical diagnosis and treatment of juxtapapillary duodenal diverticula with biliary deseases. Methods　Eighteen duodenal diverticulum treated in our department in recent 5 years were retrospectivly analyzed, especially investigated the postcholecystectomy cases whose symptoms were continuing existence after operatoins. Articles about the surgical treatment were reviewed. Results　The total of 18 duodenal diverticulum with 17 cases of juxtapapillary duodenal diverticulum were included in this study. The ages of 12 cases were over 50 years old. Sixteen cases(88.89%) presented biliary stones. Seven cases once had performed cholecystectomy or cholecystectomy plus choledochotomy,but symptoms persisted after operations. The duodenal diverticulum were found by endoscopic retrograde cholangiopancreatography (ERCP) and hypotonic duodenography. Sixteen patients underwent surgical treatment with good effect. Conclusion　The juxtapapillary duodenal diveticula has the close relationship with biliary stones. ERCP and hypotonic duodenogrphy are the most reliable methods to get the correct diagnosis. In case of recurrent common bile duct stones after operations or persisting billiary symptoms after cholecystectomy, the coexistence of juxtapapillary duodenal diverticulum should be ruled out. The surgical treatment is only considered for the duodenal diverticulum with complication.

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THE STUDY OF PHARMACOKINETICS OF 5-Fu AFTER LEFT GASTRIC ARTERY INTRA-ARTERIAL INFUSION IN TREATMENT OF GASTRIC CARCINOMA

Zhidong ZHU ; Yongdong PU

Chinese Journal of Bases and Clinics in General Surgery.2001;8(1):26-28.

Objective To evaluate the legitimate of regional artery infusion chemotherapy in the treatment of gastric carcinoma. Methods　The pharmacokinetics of 5-Fu after different route of administration was studied. Results High concentration of 5-Fu found in portal vein via left-gastric intra-artetial administration were 4-40 folds higher than the group via intravenous administration.The time of high concentrations of 5-Fu via left-gastric intra-arterial administration maintained significantly longer than by intravenous administraion. The concentration of 5-Fu in tumor tissues and paratumorous lymph tissues by intra-arterial administration were 19 times and 23 times of the group by intravenous administration. Conclusion Regional arterial infusion chemotherapy can significantly increase the concentration of chemotherapeutic drugs in the tumorous region.

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