One Hundred and Seven Middle-Aged and Senile Cases of Coronary Heart Disease with Ventricular Premature Beat Treated by Qing Xin An Shen Fang

The therapeutic principle of clearing away the heart-heat to induce tranquilization was adopted in 107 middle-aged and senile patients with ventricular premature beat of coronary heart disease on the basis of pathogenic features of phlegm, heat, blood stasis and deficiency in this condition. Qing Xin An Shen Fang ([symbol: see text] a formula for clearing away the heart-heat to induce tranquilization) was used in the treatment group and compared with mexiletine and Fu Fang Dan Shen Tablets ([symbol: see text] Compound Salvia Tablets) used in the control group. The results turned to be that the markedly effective rate was 85.1% and the total effective rate 96.3% in the treated group, better than that in the control group, with the former having a good antihypertensive and antihyperlipemic effect and an effect of improving microcirculation and clinical symptoms.

Prevalence rate of osteoporosis in the mid-aged and elderly in selected parts of China

OBJECTIVE: To understand the distribution of prevalence rate of osteoporosis in the middle - aged and elderly in parts of China. METHODS: Bone mineral density (BMD) was measured and questionnaires were taken for 5593 people aged above 40 years in five administrative areas in China selected by the stratified - multi - steps - cluster sampling method. RESULTS: The total prevalence rate of osteoporosis was 16.1%. The prevalence rate among males was 11.5% and among females was 19.9% (P

Association of low cadmium and mercury exposure with chronic kidney disease among Chinese adults aged≥80 years:A cross-sectional study

Background:The heavy metals cadmium(Cd)and mercury(Hg)are known to be widespread environmental contaminants and high occupational exposure adversely affects the risk of chronic kidney disease(CKD).However,evidence from epidemiological studies linking low Cd and Hg exposure(or non-industrial)to the risk of progression to CKD are conflicting.This study aimed to explore the association of low Cd and Hg exposure with the risk of CKD in Chinese adults aged≥80 years.Methods:The participants were recruited for the Healthy Aging and Biomarkers Cohort Study in 2017,an ongoing perspective survey conducted in longevity areas in China initially involving 3016 older adults.We used logistic regression models to estimate odds ratios(ORs)with 95%confidence intervals of CKD setting Cd and Hg as categorical variables.Logistic regression with restricted cubic spline was used to characterize a dose-response relationships between Cd or Hg concentrations and the risk of CKD in the study population.Results:The ORs for the risk of CKD comparing the fourth to the first quartile of blood Cd,blood Hg,urine Cd,and urine Hg were 1.77,1.57,2.03,and 1.50,respectively.Restricted cubic spline models showed that blood Cd and urine Hg were significantly linearly correlated with the risk of CKD,while blood Hg and urine Cd were non-linearly correlated with the risk of CKD with a steeper slope at concentrations<2.30μg/L and 3.30μg/g creatinine.Conclusions:Our findings suggest that even low Cd and Hg exposure(or non-industrial)were associated with increased risk of CKD in Chinese oldest old,although we did not find a significant multiplicative and additive interaction between Cd and Hg levels in relation to the risk of CKD.

Comparison of Coronary Artery Bypass Surgery Results in Patients under 40 and over 80

Purpose: Coronary artery disease incidence under 40 years age is increasing parallel with atherosclerotic disease at the present day while it’s seen frequently over 40. We compared the preoperative risk factors and early postoperative results of patients under 40 years age with those over 80 years age executed coronary artery bypass surgery in our clinic in this retrospective study. Patients and method: 128 patients (106 patients under 40 years age (Group 1) and 22 patients aged over 80 (Group 2)) executed coronary artery bypass surgery between January 2004 and June 2012 in our clinic are included in this study. Result: Mean age was 45.2 ± 17.2. Smoking, diabetes mellitus and high low density lipoprotein levels were the predisposing risk factors in Group 1 while hypertension and chronic obstructive pulmonary disease are predominated in the other. All patients are taken to surgical procedure under elective conditions. Aortic cross clamp duration were 37.02 ± 16.2 and 38.9 ± 13.5 minutes respectively;total cardiopulmonary bypass interval was 67.1 ± 26.3 minutes. Utilization of left internal mammarian artery was significantly higher (p = 0.01) in group 1 when compared in terms of graft management. Necessity of positive inotropic support (p = 0.033) and intraaortic balloon pump demand (p = 0.315) are found higher in Group 2. Atrial fibrillation, neurologic complications, delirium, wound infection, and postoperative revision demand are found significantly low (p = 0.136) in Group 1. There was no mortality in both groups. Discussion: Postoperative complications are seen more often in the elder group, while there was no significant difference in terms of mortality in both groups. Coronary revascularisation is safely practical in both young and elder patients with well early postoperative results and acceptable hospital mortality.

The Effect of Electro-Acupuncture on Motor Function Recovery in Patients with Acute Cerebral Infarction:A Randomly Controlled Trial

The aim of this study is to investigate the effect of electro-acupuncture treatment in acute phase of cerebral infarction on the motor functions. In this randomly controlled trial, 86 patients were allocated to two groups, the experimental group given clinical and electro-acupuncture treatments for a period of 4 weeks, and the control group given clinical treatment plus active and/or passive functional exercise. The result showed that the level of impairment and disability in both groups were improvement according to the Chinese Stroke Scale, Brunnstrom-Fugl-Meyer score, and Barthel Index throughout the study and 3 months after. The motor functions and the activities of daily living (ADL) were improved significantly in the electro-acupuncture group as compared with the control group (P

Biliary carcinoembryonic antigen levels in diagnosis of occult hepatic metastases from colorectal carcinoma

AIM:To prospectively explore the role of carcinoembryonic antigen (CEA) in gallbladder bile in patients with colorectal carcinoma and the morphological and clinical features of neoplasia and the occurrence of hepatic metastases. METHODS:CEA levels in the gallbladder and peripheral blood were studied in 44 patients with colorectal carcinoma and 10 patients with uncomplicated cholelithiasis.CEA samples were collected from the gallbladder bile and peripheral blood during the operation,immediately before extirpating the colorectal neoplasia or cholecystectomy. Values of up to 5 ng/ml were considered normal for bile and serum CEA. RESULTS:In the 44 patients with colorectal carcinoma who underwent operation with curative intent,the average level of serum CEA was 8.5 ng/ml (range:0.1 to 111.0 ng/ ml) and for bile CEA it was 74.5 ng/ml (range:0.2 to 571.0 ng/ml).In the patients with uncomplicated cholelithiasis who underwent cholecystectomy,the average level of serum CEA was 2.9 ng/ml (range:1.0 to 3.5 ng/ml) and for bile CEA it was 1.2 ng/ml (range:0.3 to 2.9 ng/ml). The average duration of follow-up time was 16.5 months (range:6 to 48 months).Four patients who underwent extirpation of the colorectal carcinoma without evidence of hepatic metastasis and with an average bile CEA value of 213.2 ng/ml presented hepatic metastases between three and seventeen months after removal of the primary colorectal neoplasia.Three of them successfully underwent extirpation of the hepatic lesions. CONCLUSION:High CEA levels in gallbladders of patients undergoing curative operation for colorectal carcinoma may indicate the presence of hepatic metastases.Such patients must be followed up with special attention to the diagnosis of such lesions.

Multiple biomarkers of colorectal tumor in a differential diagnosis model:A quantitative study

AIM:To evaluate the multiple biomarkers of colorectal tumor and their potential usage in early diagnosis of colorectal cancers. METHODS:Multiple biomarkers (DNA contents,AgNOR, PCNA,p53,c-erbB-2) in 10 normal colorectal mucosae,37 colorectal adenomas and 55 colorectal cancers were analyzed quantitatively in the computed processing imaging system. Discrimination patterns were employed to evaluate the significance of single and multiple indices in diagnosis of colorectal cancers. RESULTS:The mean values of the analyzed parameters increased in order of the normal mucosa,adenoma and adenocarcinoma,and this tendency reflected the progression of colorectal malignancy.The parameters including DNA index,positive rates,densities of AgNOR,c-erbB-2,and p53, shape and density of nucleus were relatively valuable for diagnoses.Then a diagnostic discrimination model was established.The samples were confirmed with the model, the sensitivity rates in cancer group and adenoma group were 96.36% and 89.19%,respectively.The value of proliferating cell nuclear antigen (PCNA) in early diagnosis of colorectal cancers was uncertain. CONCLUSION:The quantitative evaluation of some parameters for colorectal tumor can provide reproducible data for differential diagnosis.The established diagnostic discrimination model may be of clinicopathological value, and can make the early diagnosis of colorectal cancer possible.

380 CASES OF BRONCHIECTASIS WITH HEMOPTYSIS TREATED BY POINT-INJECTION

Hemoptysis,especially the massivehemoptysis caused by bronchiectasis is acommon,but emergent and critical diseases inclinic.Injection of Herba Houttuyniae extractinto Kongzui(LU 6)was performed to treathemoptysis according to the theory oftraditional Chinese medicine and the

Empirical antibiotic treatment with piperacillin-tazobactam in Patients with microbiologically-documented biliary tract infections

AIM: To report our experience with empiric antimicrobial monotherapy (piperacillin/tazobactam, of which no data are available in such specific circumstances) in microbiologically-documented infections in patients with benign and malignant conditions of the biliary tract.METHODS: Twenty-three patients, 10 with benign and 13 with malignant conditions affecting the biliary tree and microbiologically-documented infections were recruited and the efficacy of empirical antibiotic therapy was assessed.RESULTS: The two groups featured similar demographic and clinical data. Overall, the infective episodes were most due to Gram negative agents, more than 60% of such episodes (mostly in malignant conditions) were preceded by invasive instrumental maneuvers. Empirical antibiotic therapy with a single agent (piperacillin/tazobactam) was effective in more than 80% of cases. No deaths were reported following infections. CONCLUSION: An empiric therapeutic approach with piperacillin/tazobactam is highly effective in biliary tract infections due to benign or malignant conditions.

抗Ⅹa因子活性测定用于80岁及以上高龄患者口服利伐沙班的监测

目的探讨在口服利伐沙班的80岁及以上高龄患者中监测抗Ⅹa因子活性的意义。方法纳入2019年北京医院老年医学科高龄非瓣膜病心房颤动和静脉血栓栓塞症患者23例,口服利伐沙班抗凝治疗至少4 d后测定其抗Ⅹa因子活性的谷峰浓度,并进行服药依从性和血栓、出血等事件的随访。结果在23例高龄患者中,非瓣膜病心房颤动19例,静脉血栓栓塞症4例。利伐沙班服用剂量分别为15 mg/d 15例,10 mg/d 7例和5 mg/d 1例。监测抗Ⅹa因子活性,4例患者谷浓度大于200 ng/ml,8例患者峰浓度大于400 ng/ml(其中2例超过700 ng/ml),2例患者谷峰浓度差距较小。2例非瓣膜病心房颤动患者出院后自行停用利伐沙班,其他21例患者服药依从性较好。服药过程中3例出现黑便、便潜血阳性,1例出现血尿。19例非瓣膜病心房颤动患者抗凝过程中均未发生脑卒中事件;1例肺栓塞患者抗凝过程中再次出现下肢深静脉血栓;1例下肢深静脉血栓患者抗凝过程中发生急性心肌梗死。结论本研究中部分高龄患者抗Ⅹa因子活性的谷峰浓度明显高于国外报道水平,尤其是肾功能不全的患者,建议根据抗Ⅹa因子活性测定结果和临床不良事件调整利伐沙班剂量。

Elderly patients(≥80 years)with acute calculous cholangitis have similar outcomes as non-elderly patients(<80 years):Propensity score-matched analysis

BACKGROUND Acute cholangitis(AC)is a disease spectrum with varying extent of severity.Age≥75 years forms part of the criteria for moderate(Grade II)severity in both the Tokyo Guidelines(TG13 and TG18).Aging is associated with reduced physiological reserves,frailty,and sarcopenia.However,there is evidence that age itself is not the determinant of inferior outcomes in elective and emergency biliary diseases.There is a paucity of reports comparing clinical outcomes amongst elderly patients vs non-elderly patients with AC.AIM To investigate the effect of age(≥80 years)on AC's morbidity and mortality using propensity score matching(PSM).METHODS This is a single-center retrospective cohort study of all patients diagnosed with calculous AC(January 2016 to December 2016)and≥80 years old(January 2012 to December 2016)at a tertiary university-affiliated teaching hospital.Inclusion criteria were patients who were treated for suspected or confirmed AC secondary to biliary stones.Patients with AC on a background of hepatobiliary malignancy,indwelling permanent metallic biliary stents,or concomitant pancreatitis were excluded.Elderly patients were defined as≥80 years old in our study.A 1:1 PSM analysis was performed to reduce selection bias and address confounding factors.Study variables include comorbidities,vital parameters,laboratory and radiological investigations,and type of biliary decompression,including the time for endoscopic retrograde cholangiopancreatography(ERCP).Primary outcomes include in-hospital mortality,30-d and 90-d mortality.Length of hospital stay(LOS)was the secondary outcome.RESULTS Four hundred fifty-seven patients with AC were included in this study(318 elderly,139 non-elderly).PSM analysis resulted in a total of 224 patients(112 elderly,112 non-elderly).The adoption of ERCP between elderly and non-elderly was similar in both the unmatched(elderly 64.8%,non-elderly 61.9%,P=0.551)and matched cohorts(elderly 68.8%and non-elderly 58%,P=0.096).The overall in-hospital mortality,30-d mortality and 90-d mortality was 4.6%,7.4%and 8.5%respectively,with no statistically significant differences between the elderly and non-elderly in both the unmatched and matched cohorts.LOS was longer in the unmatched cohort[elderly 8 d,interquartile range(IQR)6-13,vs non-elderly 8 d,IQR 5-11,P=0.040],but was comparable in the matched cohort(elderly 7.5 d,IQR 5-11,vs non-elderly 8 d,IQR 5-11,P=0.982).Subgroup analysis of patients who underwent ERCP demonstrated the majority of the patients(n=159/292,54.5%)had delayed ERCP(>72 h from presentation).There was no significant difference in LOS,30-d mortality,90-d mortality,and in-hospital mortality in patients who had delayed ERCP in both the unmatched and matched cohort matched cohort:in-hospital mortality[n=1/42(2.4%)vs 1/26(3.8%),P=0.728],30-d mortality[n=2/42(4.8%)vs 2/26(7.7%),P=0.618],90-d mortality[n=2/42(4.8%)vs 2/26(7.7%),P=0.618],and LOS(median 8.5 d,IQR 6-11.3,vs 8.5 d,IQR 6-15.3,P=0.929).CONCLUSION Mortality is indifferent in the elderly(≥80 years old)and non-elderly patients(<80 years old)with AC.

Paint-bake response of AZ80 and AZ31 Mg alloys

Aging behaviors of extruded and rolled AZ80 and AZ31 Mg alloys were investigated under conditions similar to the paint-bake cycle currently used in automotive industry.Artificial aging at 170℃ from 0.5 to 12 h was conducted on solution-treated specimens to study the effects of aging on mechanical properties.SEM observations and EDS data show thatβ-phase of Al12Mg17 precipitates continuously or discontinuously fromα-Mg matrix and distributes along grain boundaries of the AZ80 alloy during artificial aging.Data of tensile tests and Vickers hardness tests show that an optimum mechanical property is achieved after baking at 170℃ for 6-8 h when Vickers hardness,tensile strength,and elongation are increased by 6.35%,15.30%,and 7.88%,respectively, while the AZ31 alloy does not exhibit significant hardening behavior over the aging period.

Experimental investigation on ablation characteristics of coated and uncoated steel under 30/80 μs impulse current

The ablation tests on coated and uncoated Q235 B steel sheets were conducted under 30/80 μs impulse current simulating the lightning first return stroke current, aimed at further understanding the ablation characteristics of steel and investigating the impact of anti-corrosion coating on these characteristics. Ablation characteristics were investigated through the macroscopic morphology and x-ray diffraction patterns on the surface of damaged zones, the microstructure and micro Vickers hardness on the cross-section of damaged zones, and the maximum rear-face temperature of sample sheets. It can be concluded that the ablation areas of uncoated sheet consist of the melted layer and the heat-affect layer. These ablation areas include not only the area ablated directly by the arc root, of which the depth is deeper, but also the area forming due to the splashing of molten steel, of which the depth is shallower and decreases when the area’s distance from the arc attachment point increases. For coated sheet, coating materials have decomposed and evaporated forming an ablation pit on the sheet surface, in which the steel surface is exposed, and zinc filler of coating primer has infused into the exposed surface. The ablation diameter of uncoated sheet relates to the amplitude of the 30/80 μs impulse current in quadratic function, while for coated sheet, the relation is linear. In general, under the 30/80 μs impulse current, the coating can decrease the energy injected from the arc to the steel sheet and reduce the melting and splashing of steel. As a result, the ablation severity of uncoated sheet is severer than that of coated sheet.

Clinicopathological analysis of patients with gastric cancer in 1200 cases

INTRODUCTIONGastric cancer is one of the most common fatal malignancies in the world. The prognosis is generally poor in advanced gastric cancer .The low survival is related to delayed diagnosis, metastasis and recurrence after operation .The aim of this paper was to find correlation between clinical factors was to find correlation between clinical factors and biologic behavior of gastric cancer in a series of 1200 patients undergoing surgical resection.

Colonoscopic screening and follow-up for coiorectal cancer in the elderly

AIM: To improve the prevention and treatment of senile patients with colorectal cancer by evaluating the importance of colonoscopy in clinical screening and follow-up. METHODS: Clinical screening of colonoscopy was performed for 2196 patients aged 60-90 years old according to the protocol,and 1740 of them (79.2%) were followed-up. RESULTS: Colorectal cancer was found in 52 patients, and the detectable rate was 2.4%. Among them, 19 were diagnosed as early colorectal cancer, accounting for 36.5% of the detected colorectal cancer. Among the followed-up patients, early colorectal cancer was found in 9, accounting for 45.0% of the detected colorectal cancer. The resectable rate and 5 years survival rate of colorectal cancer were 97.7% and 80.9% respectively. The incidence of complication was 0.05%, and the successful rate of cecum intubation was 98.9%. CONCLUSION: Colonoscopic screening and follow-up of the elderly for colorectal cancer and pre-cancerous lesion (adenomatoid polyp) can increase the detectable rate of early colorectal cancer and improve its prevention and treatment.

Racial differences in the anatomical distribution of colorectal cancer:a study of differences between American and Chinese patients

AIM: To compare the racial differences of anatomical distribution of colorectal cancer (CRC) and determine the association of age, gender and time with anatomical distribution between patients from America (white) and China (oriental).METHODS: Data was collected from 690 consecutive patients in Cleveland Clinic Florida, U.S.A. and 870consecutive patients in Nan Fang Hospital affiliated to the First Military Medical University, China over the past 11years from 1990 to 2000. All patients had colorectal adenocarcinoma diagnosed by histology and underwent surgery.RESULTS: The anatomical subsite distribution of tumor,age and gender were significantly different between white and oriental patients. Lesions in the proximal colon (P＜0.001) were found in 36.3 % of white vs 26.0 % of oriental patients and cancers located in the distal colon and rectum in 63.7 % of white and 74 % of oriental patients (P＜0.001). There was a trend towards the redistribution from distal colon and rectum to proximal colon in white males over time, especially in older patients (＞80 years).No significant change of anatomical distribution occurred in white women and Oriental patients. The mean age at diagnosis was 69.0 years in white patients and 48.3 years in Oriental patients (P＜0.001).CONCLUSION: This is the first study comparing the anatomical distribution of colorectal cancers in whites and Chinese patients. White Americans have a higher risk of proximal CRC and this risk increased with time. The proportion of white males with CRC also increased with time.Chinese patients were more likely to have distal CRC and developed the disease at a significantly earlier age than white patients. These findings have enhanced our understanding of the disease process of colorectal cancer in these two races.

Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype:Results of a 25-year follow-up study

AIM:IBD is a systemic disease associated with a large number of extraintestinal manifestations (EIMs).Our aim was to determine the prevalence of EIMs in a large IBD cohort in Veszprem Province in a 25-year follow-up study. METHODS:Eight hundred and seventy-three IBD patients were enrolled (ulcerative colitis/UC/:619,m/f:317/302, mean age at presentation:38.3 years,average disease duration:11.2 years;Crohn's disease/CD/:254,m/f:125/129, mean age at presentation:32.5 years,average disease duration:9.2 years).Intestinal,extraintestinal signs and laboratory tests were monitored regularly.Any alteration suggesting an EIMs was investigated by a specialist. RESULTS:A total of 21.3% of patients with IBD had EIM (UC:15.0%,CD:36.6%).Age at presentation did not affect the likelihood of EIM.Prevalence of EIMs was higher in women and in CD,ocular complications and primary sclerosing cholangitis (PSC) were more frequent in UC.In UC there was an increased tendency of EIM in patients with a more extensive disease.Joint complications were more frequent in CD (22.4% vsUC 10.2%,P<0.01).In UC positive family history increased the risk of joint complications (OR:3.63).In CD the frequency of type-1 peripheral arthritis was increased in patients with penetrating disease (P=0.028).PSC was present in 1.6% in UC and 0.8% in CD.Dermatological complications were present in 3.8% in UC and 10.2% in CD,the rate of ocular complications was around 3% in both diseases.Rare complications were glomerulonephritis,autoimmune hemolytic anaemia and celiac disease. CONCLUSION:Prevalence of EIM in Hungarian IBD patients is in concordance with data from Western countries.The high number of EIM supports a role for complex follow-up in these patients.

Gastric polypoid lesions:Analysis of 150 endoscopic polypectomy specimens from 91 patients

AIM:To analyze gastric polypoid lesions in our patient- population with respect to histopathologic features and demographic,clinical,and endoscopic characteristics of patients. METHODS:Clinical records and histopathologic reports of patients with gastric polypoid lesions were analyzed retrospectively.All lesions had been totally removed by either endoscopic polypectomy or hot biopsy forceps.The histopathologic slides were re-evaluated by the same histopathologist. RESULTS:One-hundred and fifty gastric polypoid lesions were identified in 91 patients.There were 53(58 %)women and 38(42 %)men with a median age of 53(range,31 to 82)years.The most frequent presenting symptom was dyspepsia that was observed in 35(38.5 %)patients. Symptoms were mostly related to various associated gastric abnormalities such as chronic gastritis or H pylori infection rather than polypoid lesion itself.Polypoid lesions were commonly located in the antrum followed by cardia.Out of 150 lesions,80(53 %)had the largest dimensions less than or equal to 5 mm and only 7 were pedunculated.The frequencies of hyperplastic polyps,foveolar hyperplasia,and fundic gland polyps were 46 %,18 %,and 14 % respectively. We also detected gastritis varioliformis in 12 specimens, lymphoid follicles in 9,4 adenomatous polyps in 4,polypoid lesions with edematous mucosa in 4,inflammatory polyps in 3,and carcinoid tumor in 1.Adenomatous changes were observed within two hyperplastic polyps and low grade dysplasia in one adenoma.Histopathologic evaluation of the surrounding gastric mucosa demonstrated chronic gastritis in 72(79 %)patients and H pylori infection in 45(49 %). CONCLUSION:Hyperplastic polyps are the mbst frequently encountered subtype of gastric polypoid lesions.They are usually associated with chronic gastritis or H pylori gastritis.Contrary to the previous belief,they may harbour adenomatous changes or dysplastic foci. Therefore,endoscopic polypectomy seems as a safe and fast procedure for both diagnosis and treatment of gastric polypoid lesions at the same session.In addition, edematous mucosa may appear misleadingly as a polypoid lesion in some instances and it can be ruled out only by histopathologic examination.

Natural history of chronic hepatitis C in patients on hemodialysis: Case control study with 4-23 years of follow-up

AIM:Hepatitis C virus(HCV)infection is very common among end-stage kidney disease patients on hemodialysis,but its natural history is not known. METHODS:In this study,189 dialysis patients(case) positive for HCV antibodies who were followed up for more than 4 years were compared with twice as many sex/age matched controls with chronic hepatitis C who were diagnosed in the same month as the case and followed up for comparable periods.The longest follow-up was 23 years in dialysis cases. The disease activities were graded into'asymptomatic'if ALT was less than 40(35 in cases)IU/L,'low activities'if ALT was 40(35)-79 IU/L,and'high activities'if ALT was above 80 IU/L during the last or latest 4 year period. RESULTS:All 25 dialysis cases who were followed up for more than 15 years were asymptomatic and 15 of them were negative for HCV RNA.Of the 50 controls followed up for more than 15 years,34 had high activities,and none deared HCV RNA.There were 60 controls who were asymptomatic, but they were all positive for HCV RNA,while 22.3% of asymptomatic dialysis cases were RNA negative.No dialysis patients with chronic hepatitis C progressed to cirrhosis, whereas the disease progressed to cirrhosis in more than one quarter of the controls.These differences were highly significant(P<0.0001). CONCLUSION:Chronic hepatitic C among hemodialysis patients is mild in disease activity,and is not progressive, perhaps due to immunological abnormalities in these patients. Hepatic C virus is frequently cleared in asymptomatic dialysis patients during a long course.A possible mechanism for viral clearance is viral particle destruction on the surface of the dialyzer membrane.

Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy:Prognostic factors and survival

AIM: To identify the prognostic factors with regard to survival for patients with brain metastasis from primary tumors of the gastrointestinal tract. METHODS: Nine hundred and sixteen patients with brain metastases, treated with whole brain radiation therapy (WBRT) between January 1985 and December 2000 at the Department of Radiation Oncology, University Hospital Freiburg, were analyzed retrospectively. RESULTS: Fifty-seven patients presented with a primary tumor of the gastrointestinal tract (esophagus: n=0, stomach: n=10, colorectal: n=47). Twenty-six patients had a solitary brain metastasis, 31 patients presented with multiple brain metastases. Surgical resection was performed in 25 patients. WBRT was applied with daily fractions of 2 Gray (Gy) or 3Gy to a total dose of 50Gy or 30Gy, respectively. The interval between diagnoses of the primary tumors and brain metastases was 22.6mo vs 8.0mo for patients with primary tumors of the colon/rectum vs other primary tumors, respectively (P<0.01, log-rank). Median overall survival for all patients with brain metastases (n=916) was 3.4mo and 3.2mo for patients with gastrointestinal neoplasms. Patients with gastrointestinal primary tumors presented significantly more often with a solitary brain metastasis than patients with other primary tumors (P<0.05, log-rank). In patients with gastrointestinal neoplasms (n=57), the median overall survival was 5.8 mo for patients with solitary brain metastasis vs 2.7mo for patients with multiple brain metastases (P<0.01, log-rank). The median overall survival for patients with a Karnofsky performance status (KPS) ≥70 was 5.5mo vs 2.1mo for patients with KPS <70 (P<0.01, log-rank). At multivariate analysis (Cox Model) the performance status and the number of brain metastases were identified as independent prognostic factors for overall survival. CONCLUSION: Brain metastases occur late in the course of gastrointestinal tumors. Pretherapeutic variables like KPS and the number of brain metastases have a profound influence on treatment outcome.