中式西餐餐盘设计探究——餐盘设计与“切”“舀”取食动作的关联

本文从现代中式西餐餐盘设计的角度入手,以西餐在中国发展的历史为切入点,将传统西餐文化和西餐在中国的发展流行文化进行对比,是什么使得在特定的人文,地域环境下用不同种盘类,这就是盘类设计研究的必要性,称之为盘的工业产品种类越来越多,本题主要研究餐盘,以人文化地域化特征为主线,并结合相关设计作品加以分析,介绍了餐盘设计对中式西餐用餐产生的影响。

回肠可控膀胱及输尿管、回盲肠、乙状结肠吻合术临床应用体会

膀胱全切或因某种病变不能沿正常解剖途径排出尿液时相继而来的问题就是尿流改道。其中需行尿流改道的疾病中,以膀胱癌为数最多,占64％。我院自1989年以来对膀胱全切患者施行回肠可控膀胱(5例),输尿管、回盲肠、乙状结肠吻合(6例)两种可控性尿流改道术式,获得满意效果。

Esophagectomy for locally advanced esophageal cancer, followed by chemoradiotherapy and adjuvant chemotherapy

AIM： To compare the efficacy and toxicity of a three-step combination therapy with post-operative radiation alone for locally advanced esophageal cancer.METHODS： Patients with T3-4 and N0-1 esophageal carcinoma from a number of institutions were non-randomly, prospectively enrolled in the study. All patients underwent single-stage curative en bloc esophagectomy. The patients were then assigned into one of two treatment groups based on treatment consisting of either post-operative concurrent chemoradiotherapy （CCRT） with weekly cisplatin 30 mg/m^2 followed by systemic adjuvant chemotherapy （four monthly cycles of cisplatin 20 mg/m^2 and 5-fluorouracil 1 000 mg/m^2 for five consecutive days）, or, post-operative radiation alone. The radiotherapy dose was 55-60 Gy for all patients. Primary end-point of this study was to assess the per-protocol patients＇ improvement of overall survival benefit. Secondary end-point was designed to evaluate both the per-protocol and intent-totreat patients＇ outcome of survival. RESULTS： A total of 60 patients （n=30 per group） were enrolled in this study. The two groups were generally comparable for demographic characteristics and hematological and non-hematological toxicities. The CCRT with weekly cisplatin was well tolerated, with significantly better overall survival （30.9 mo vs 20.7 mo; 95% CI, 27.5-36.4 vs 15.2-26.1） and 3-year survival （70.0% vs 33.7%; P=0.003）. Low histological grade of tumor （P〈0.001） was associated with favorable survival in these locally advanced patients. CONCLUSION： For locally advanced esophageal cancer, the combination of esophagectomy, post-operative CCRT with weekly cisplatin and systemic adjuvant chemotherapy is well tolerated and effective. A large-scale, prospective randomized trial of this regimen is in progress.

Clinicopathologic characteristics of esophagectomy for esophageal carcinoma in elderly patients

AIM： To evaluate the risk of esophagectomy for carcinoma of the esophagus in the elderly （70 years or more） compared with younger patients （〈70 years） and to determine whether the short-term outcomes of esophagectomy in the elderly have improved in recent years. METHODS： Preoperative risks, postoperative morbidity and mortality in 60 elderly patients （≥70 years） with esophagectomy for carcinoma of the esophagus were compared with the findings in 1 782 younger patients （〈70 years） with esophagectomy between 3anuary 1990 and December 2004. Changes in perioperative outcome and short-time survival in elderly patients between 1990 to 1997 and 1998 to 2004 were separately analyzed. RESULTS： Preoperatively, there were significantly more patients with hypertension, pulmonary dysfunction, cardiac disease, and diabetes mellitus in the elderly patients as compared with the younger patients. No significant difference was found regarding the operation time, blood loss, organs in reconstruction and anastomotic site between the two groups, but elderly patients were more often to receive blood transfusion than younger patients. Significantly more transhiatal and fewer transthoracic esophagectomies were performed in the elderly patients as compared with the younger patients. Resection was considered curative in 71.66% （43/60） elderly and 64.92% （1 157/1 782） younger patients, which was not statistically significant （P〉0.05）. There were no significant differences in the prevalence of surgical complications between the two groups. Postoperative cardiopulmonary medical complications were encountered more frequently in elderly patients. The hospital mortality rate was 3.3% （2/60） for elderly patients and 1.1% （19/1 782） for younger patients without a significant difference. When the study period was divided into a former （1990 to 1997） and a recent （1997 to 2004） period,operation time, blood loss, and percentage of patients receiving blood transfusion of the elderly patients significantly improved from the former period to the recent period. The hospital mortality rate of the elderly patients dropped from the former period （5.9%） to the recent period （2.3%）, but it was not statistically significant. CONCLUSION： Preoperative medical risk factors and postoperative cardiopulmonary complications after esophagectomy are more common in the elderly, but operative mortality is comparable to that of younger patients. These encouraging results and improvements in postoperative mortality and morbidity of the elderly patients in recent period are attributed to better surgical techniques and more intensive perioperative care in the elderly.

Esophagotracheal fistula caused by gastroesophageal reflux 9 years after esophagectomy

Fistula between digestive tract and airway is one of the complications after esophagectomy with lymph node dissection. A case of esophagotracheal fistula secondary to esophagitis 9 years after esophagectomy and gastric pull-up for treatment of esophageal carcinoma is described. It was successfully treated with transposition of a pedicled pectoralis major muscle flap.

Pulmonary complications in patients with chronic obstructive pulmonary disease following transthoracic esophagectomy

AIM： To investigate the incidence of various types of postoperative pulmonary complications （POPCs） and to evaluate the significance of perioperative arterial blood gases in patients with esophageal cancer accompanied with chronic obstructive pulmonary disease （COPD） after esophagectomy. MEHTODS： Three hundred and fifty-eight patients were divided into POPC group and COPD group. We performed a retrospective review of the 358 consecutive patients after esophagectomy for esophageal cancer with or without COPD to assess the possible influence of COPD on postoperative pulmonary complications. We classified COPD into four grades according to percent-predicted forced expiratory volume in 1 s （FEV1） and analyzed the incidence rate of complications among the four grades. Perioperative arterial blood gases were tested in patients with or without pulmonary complications in COPD group and compared with POP（： group. RESULTS： Patients with COPD （29/86, 33.7%）had more pulmonary complications than those without COPD （36/272, 13.2%） （P〈0.001）. Pneumonia （15/29, 51.7%）, atelectasis （13/29, 44.8%）, prolonged 02 supplement （10/29, 34.5%）, and prolonged mechanical ventilation （8/29, 27.6%） were the major complications in COPD group. Moreover, patients with severe COPD （grade Ⅱ B, FEV1 〈 50% of predicted） had more POPCs than those with moderate（gradeⅡA,50%-80% of predicted） and mild （grade Ⅰ≥80% of predicted） COPD （P〈0.05）. PaO2 was decreased and PaCO2 was increased in patients with pulmonary complications in COPD group in the first postoperative week.CONCLUSION： The criteria of COPD are the critical predictor for pulmonary complications in esophageal cancer patients undergoing esophagectomy. Severity of COPD affects the incidence rate of the pulmonary complication,and percent-predicted FEV1 is a good predictive variable for pulmonary complication in patients-with COPD.Arterial blood gases are helpful in directing perioperative management.

Endoscopic Mucosal Resection

Endoscopic mucosal resection is indicated in limited esophageal carcinomas with in?ltration of the mucosa. As submucosal cancer is combined with a rate of lymph node metastasis in up to 30% mucosectomy is not the procedure of choice. The main techniques of endoscopic mucosal resection are the “suck and cut” technique using a cap on the endoscope or a ligation device to create a pseudocroup of the carcinoma. Submucosal injection of saline or other solutions is recommended prior to diathermic mucosectomy in order to reduce the risk of perforation or haemorrhage. The long term results of endoscopic mucosal resection show tumor speci?c 5 year survival rates of about 97% especially if the indication is restricted to m1 and m2 mucosal carcinomas.

Surgical resection for esophageal carcinoma: Speaking the language

The terminology used to describe esophagectomy for carcinoma can be confusing, even for specialists in gastrointestinal disease. As a result, specific terms are often used out of their intended context. To simplify the nomenclature, two points regarding procedures for surgical resection of the esophagus are critical: the extent of resection (radical vs standard) and the operative approach (choice of incisions). It is important to understand that the radicality of the resection may have little to do with the operative approach, with the exception of esophagectomy without thoracotomy (transhiatal esophagectomy), which mandates the performance of a standard or non-radical resection. Esophagectomy has emerged as the standard curative treatment option for patients with esophageal carcinoma; however, unlike the surgical resection of other types of solid tumors, many different surgical options and/or approaches exist for these patients. This heterogeneity of care may result from the fact that the esophagus is accessible through more than one body cavity (left hemithorax, right hemithorax, abdomen).In addition, and partially as a result of its accessibility,different types of surgical specialists harbor this operation in their armamentarium, including general surgeons,thoracic surgeons, and surgical oncologists. Despite this enthusiasm amongst surgeons, little consensus exists as to which option is most oncologically sound. Further, the details of the various surgical approaches and procedures for resection of the esophagus are often difficult to comprehend, even for specialists in gastrointestinal disease, with much of the relevant terminology used out of its intended context. To facilitate the understanding of the surgical options for esophageal carcinoma, it is useful to view the operation from two angles: the extent of resection (Aradical@ vs Astandard@) and the operative approach (choice of incisions).

Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy for squamous cell carcinoma of the lower thoracic esophagus

AIM： To evaluate the clinical outcome of Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy for patients with squamous cell carcinoma of the lower thoracic esophagus. METHODS： From January 1998 to December 2001, 73 patients with lower thoracic esophageal carcinoma underwent Ivor-Lewis subtotal esophagectomy with two-field lymphadenectomy. Clinicopathological information, postoperative complications, mortality and long term survival of all these patients were analyzed retrospectively. RESULTS： The operative morbidity and mortality was 15.1% and the mortality was 2.7%. Lymph node metastases were found in 52 patients （71.2%）. Nodal metastases to the upper, middle, lower mediastini and upper abdomen were found in 13 （17.8%）, 15 （20.5%）, 30 （41.1%）, and 25 （34.2%） patients, respectively. Postoperative staging was as follows： stage Ⅰ in 5 patients, stage Ⅱ in 34 patients, stage Ⅲ in 32 patients, and stage Ⅳ in 2 patients, respectively. The overall 5-year survival rate was 23.3%. For NO and N1 patients, the 5-year survival rate was 38.1% and 17.3%, respectively （X^2 = 22.65, P 〈 0.01）. The 5-year survival rate for patients in stages Ⅱ a, Ⅱ b and Ⅲ was 31.2%, 27.8% and 12.5%, repsectively （X^2 = 29.18, P 〈 0.01）. CONCLUSION： Ivor Lewis subtotal esophagectomy with two-field （total mediastinum） lymphadenectomy is a safe and appropriate operation for squamous cell carcinoma of the lower thoracic esophagus.

Transthoracic En-bloc Esophagectomy

In patients with esophageal carcinoma surgical resection remains the standard of curative treatment. For locally advanced tumors (pT1sm–pT3) transthoracic esophagectomy with extended lym- phadenectomy is the standard surgical procedure since it o?ers a complete removal of the primary tumor and possible lymph node metastases. This surgical resection is appropriate for squamous cell but also adenocarcinoma of the esophagus because both histological entities demonstrate a lymphatic spread to the abdominal compartment and the upper mediastinum. In-hospital mortality rates are between 6% and 9%; anastomotic leakage and pulmonary complications mainly contribute to postoperative morbidity. In terms of 5-year survival the transthoracic procedure o?ers a better prognosis compared to the transhiatal resection. 五笔字型计算机汉字输入技术

Successful treatment for esophageal carcinoma with lung metastasis by induction chemotherapy followed by salvage esophagectomy: Report of a case

We here report a case of a 51-year-old man with lung metastasis from esophageal carcinoma that was initially treated by combination chemotherapy consisting of fluorouracil and nedaplatin. Because metastatic disease disappeared, salvage esophagectomy was performed. Although chest wall recurrence developed at the thoracotomy wound, prolonged survival of 48 months was achieved by local tumor resection and additional chemotherapy. This combination chemotherapy is regarded as a promising and considerable treatment for metastatic esophageal carcinoma.

Management of esophageal mucosa with high-grade dysplasia

Objective:Early detection and treatment in patients with esophageal cancer is the most effective way to improve the prognosis. Patients with high-grade dysplasia(HGD) in esophageal mucosa might be involved with early esophageal cancer,but the management of the disease is controversial. The purpose of our study was to explore the management of esophageal mucosa with HGD. Methods:We retrospectively analyzed 10 patients with HGD in esophageal mucosa,who underwent esophagectomy in Cancer Hospital of Fudan University from 1999 to 2006. The surgical approach,postoperative morbidity,in-hospital complications and pathological results of the patients were analyzed. Basing on our data together with other studies,we aimed at looking for an appropriate management for patients with HGD. Results:Of the 10 patients who received esophagectomy,the pathological results showed that 2(20%) cases were in situ carcinoma and 8(80%) cases were invasive cancer with no regional lymph nodes involved. 30-day mortality was 0. One patient experienced cervical anastomotic leakage,but healed in 2 weeks. There was no pulmonary complication. Conclusion:Most patients with HGD actually have occult carcinoma. High percentage of patients with HGD would develop into cancer during their lifetime. Esophagectomy is now a selective approach for the treatment of the patients with HGD.

Endoscopic ablation of Barrett's esophagus using high power setting argon plasma coagulation: A prospective study

AIM: This prospective study evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of Barrett's esophagus (BE) that is considered to be the main risk factor for the development of esophageal adenocarcinoma.METHODS: The results from 25 patients, observed at the First Department of General Surgery, University of Verona, Italy, from October 2000 to October 2003, who underwent APC for histologically proven BE were prospectively analyzed.RESULTS: The ablation treatment was completed in all the patients but one (96%). The mean number of APC sessions needed to complete ablation was 1.6 (total number: 40). The eradication was obtained in the majority of cases by one session only (60%), two sessions were required in 24% of the cases and three or more in 16%.About 43% of the sessions were complicated. Retrosternal pain (22.5%) and fever (17.5%) were the most frequent symptoms. Only one major complication occurred, it was an hemorrhage due to ulcer formation on the treated esophagus that required urgent endoscopic sclerosis and admission. The follow-up was accomplished in all the patients with a mean period of 26.3 mo and 20 patients (84%) with a follow-up period longer than 24 mo. Only one patient showed a relapse of metaplastic mucosa 12 mo after the completion of ablation. The patient was hence re-treated and now is free from recurrence 33 mo later.CONCLUSION: High power setting (90 W) APC showed to be safe and effective. The effects persist at a mean follow-up period of two years with a comparable cost in term of complications with respect to standard power settings. Further studies with greater number of patients are required to confirm these results and to assess if ablation reduces the incidence of malignant progression.

Evaluation of two esophageal myotomy methods to treat achalasia

Objective:To evaluate a better method for the outcome of achalasia between laparoscopic Heller procedures(LHP)with partial fundoplications and thoracoscopic procedures(TP).Methods: Eighty patients with achalasia were treated by LHP with partial fundoplications and another 120 cases re- ceived TP treatment.All the patients were from the First and Second Hospital of Xi'an Jiaotong Universi- ty.Their clinical information including dysphagia after surgery,operation time,staying in hospital,ab- normal gastroesophageal reflux and pH assay were recorded.Results:Achalasia treated by LHP with par- tial fundoplications can make a higher outcome remission rate compared to TP.Conclusion:LHP with par- tial fundoplications is better than TP.It is an ideal surgery for achalasia up to now.

Clinical application of thoracic small incision in radical operation for lung and esophageal cancer

Objective: The aim of this study was to explore clinical value of thoracic small incision in radical operation for lung and esophageal cancer in assuring same treatment effects with conventional incision. Methods: Collected data of patients was given radical operation for lung and esophageal cancer in our department from January 1, 2006 to January 1, 2007, and performed retrospective analysis, among them, small incision group (improved group) was 143 cases, and conventional group was 167 cases including 6 cases which was changed from small incision to conventional incision in operation. Compared operation time, incision length, intraoperative blood loss, postoperative drainage flow, number of lymph node dissected, recovery time of postoperative upper limb function, postoperative pain, postoperative complications etc. between both groups. Results: Compared with conventional group, intraoperative blood loss, postoperative drainage flow, postoperative pain, recovery time of postoperative upper limb function in improved group was improved significantly, and there was no obvious difference in operation time and number of lymph node dissected between both groups. Conclusion: Small incision in radical operation for lung and esophageal cancer is small trauma, and quick recovery after operation, treatment effects of it is basically similar to that of conventional operation method, however, its application is limited in few cases.

CLINICAL SUMMARY ON ACUPUNCTURE COMBINED WITH ENFLURANE-INHALATION ANESTHESIA FOR RESECTION OF ESOPHAGEAL CARCINOMA

Objective: To observe the clinical effect of acupuncture combined with general anesthesia by inhaling enflurane for esophageal carcinoma resection. Methods: 120 cases of esophageal carcinoma patients were randomly divided into acupuncture+inhalation of enflurane (A+IE, n=40), electrical stimulation (ES)+IE (n=41) and IE (control, n=39) groups. In all the 3 groups, vecuronium, fentanyl, propofol (same dose) were given intravenously to induce anesthesia before operation, and during operation, fentanyl (2 ug/kg/hr) and vecuronium (0.03 mg/kg/0.5hr) and appropriate concentration of enflurane were given to the patients for maintaining anesthesia and muscular relaxation. In group A, Xiayifeng (below TE 17), Sanyangluo (TE 8) to Ximen (PC 4) were punctured and stimulated electrically, and in group B, these acupoints were stimulated electrically via cutaneous plate electrodes. Results: The anesthetic effect grade I rates of A+IE, ES+IE and IE groups were 67.50%, 68.29% and 28.21% respectively. There was a significant difference between A+IE or ES+IE and IE groups (P<0.001). In the process of anesthesia, the mean concentrations of the inhaled enflurane in A +IE, ES+IE and IE groups were 0.55% and 0.50% and 0.83% separately. The average concentrations of A+IE and ES+IE groups were lower 33.73% and 39.76% than that of group IE (P<0.005). Conclusion: Acupuncture combined with enflurane inhalation can enhance anesthetic effect, reduce the dose of the inhaled enflurane.

Evaluation of three-incision esophagectomy:Review of 1226 patients

Objective:The aim of our study was to evaluate the clinical effect and the prospect of the three-incision (right thoracotomy, midline laparotomy and left cervical incisions) esophagectomy for the treatment of esophageal carcinoma.Meth-ods:We reviewed our experience with 1226 patients undergoing three-incision esophagectomy for middle and upper esopha-geal carcinoma.Results:Anastomotic leak rates were determined for the entire group.The overall leak rate was 8.5% (104 patients).Overall hospital mortality was 0.24% (3 patients).No patient died as a result of anastomotic leakage.Conclusion:The three-incision technique can radically remove carcinoma and perform a complete lymphadenectomy.Although the cervical anastomotic leak rate is slightly high, the management of this complication is relatively easy and the satisfactory results can be achieved.

Laparoscopic Heller myotomy with or without partial fundoplication: A matter of debate

AIM: To present our experience of laparoscopic Heller stretching myotomy followed by His angle reconstruction as surgical approach to esophageal achalasia.METHODS: Thirty-two patients underwent laparoscopic Heller myotomy; an anterior partial fundoplication in 17,and angle of His reconstruction in 15 cases represented the antireflux procedure of choice.RESULTS: There were no morbidity and mortality recorded in both anterior funduplication and angle of His reconstruction groups. No differences were detected in terms of recurrent dysphagia, p.o. reflux or medical therapy.CONCLUSION: To reduce the incidence of recurrent achalasia after laparoscopic Heller myotomy, we believe that His' angle reconstruction is a safe and effective alternative to the anterior fundoplication.

Proposed criteria to differentiate heterogeneous eosinophilic gastrointestinal disorders of the esophagus, including eosinophilic esophageal myositis

AIM To define clinical criteria to differentiate eosinophilic gastrointestinal disorder(Eo GD) in the esophagus. METHODS Our criteria were defined based on the analyses of the clinical presentation of eosinophilic esophagitis(Eo E), subepithelial eosinophilic esophagitis(s Eo E) and eosinophilic esophageal myositis(Eo EM), identified by endoscopy, manometry and serum immunoglobulin E levels(s-Ig E), in combination with histological and polymerase chain reaction analyses on esophageal tissue samples.RESULTS In five patients with Eo E, endoscopy revealed longitudinal furrows and white plaques in all, and fixed rings in two. In one patient with s Eo E and four with Eo EM, endoscopy showed luminal compression only. Using manometry, failed peristalsis was observed in patients with Eo E and s Eo E with some variation, while Eo EM was associated with hypercontractile or hypertensive peristalsis, with elevated s-Ig E. Histology revealed the following eosinophils per high-power field values. Eo E = 41.4 ± 7.9 in the epithelium and 2.3 ± 1.5 in the subepithelium; s Eo E = 3 in the epithelium and 35 in the subepithelium(conventional biopsy); Eo EM = none in the epithelium, 10.7 ± 11.7 in the subepithelium(conventional biopsy or endoscopic mucosal resection) and 46.8 ± 16.5 in the muscularis propria(peroral esophageal muscle biopsy). Presence of dilated epithelial intercellular space and downward papillae elongation were specific to Eo E. Eotaxin-3, IL-5 and IL-13 were overexpressed in Eo E.CONCLUSION Based on clinical and histological data, we identified criteria, which differentiated between Eo E, s Eo E and Eo EM, and reflected a different pathogenesis between these esophageal Eo GDs.

Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma:A meta-analysis

AIM:To compare neoadjuvant chemoradiotherapy and surgery with surgery alone for resectable esophageal carcinoma. METHODS:We used MEDLINE and EMBASE databases to identify eligible studies and manual searches were done to ensure no studies were missed.Trial validity assessment was performed and a trial quality score was assigned. RESULTS:Eleven randomized controlled trials(RCTs) including 1308 patients were selected.Neoadjuvant chemoradiotherapy significantly improved the overall survival compared with surgery alone.Odds ratio(OR) [95%confidence interval(CI),P value],expressed as neoadjuvant chemoradiotherapy and surgery vs surgery alone,was 1.28(1.01-1.64,P=0.05)for 1-year survival,1.78(1.20-2.66,P=0.004)for 3-year survival,and 1.46(1.07-1.99,P=0.02)for 5-year survival.Postoperative mortality increased in patients treated by neoadjuvant chemoradiotherapy(OR: 1.68,95%CI:1.03-2.73,P=0.04),but incidence of postoperative complications was similar in two groups (OR:1.14,95%CI:0.88-1.49,P=0.32).Neoadjuvant chemoradiotherapy lowered the local-regional cancer recurrence(OR:0.64,95%CI:0.41-0.99,P=0.04), but incidence of distant cancer recurrence was similar (OR:0.94,95%CI:0.68-1.31,P=0.73).Histological subgroup analysis indicated that esophageal squamous cell carcinoma did not benefit from neoadjuvantchemoradiotherapy,OR(95%CI,P value)was 1.16(0.85-1.57,P=0.34)for 1-year survival,1.34 (0.98-1.82,P=0.07)for 3-year survival and 1.41 (0.98-2.02,P=0.06)for 5-year survival. CONCLUSION:Neoadjuvant chemoradiotherapy can raise the survival rate of patients with esophageal adenocarcinoma.