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Biomedical subjects

J Wong

Publications and source records attributed to J Wong.

At least 577 records · Page 32Linked to original sources

Idiotype-specific T lymphocytes responsible for the selection of somatic variants of a B cell hybrid.

A B cell hybrid (2C3E1), which when cultivated in vitro stably expresses a serologically defined private idiotype on the cell surface, undergoes a somatic variation which culminates in the generation of idiotype-negative variants when propagated as a tumor in syngeneic BALB/c mice. Lyt-1+ and Lyt-2- BALB/c T cells derived from appropriately primed spleen cells when co-cultured with 2C3E1 tumor cells in vitro are responsible for the generation or selection of the idiotype-negative tumor variants. The idiotype-specific effector T cells responsible for the variant production in vitro and in vivo are triggered either by viable or irradiated 2C3E1 tumor cells, but not by soluble idiotype-positive monoclonal antibody secreted by the tumor. The idiotype-positive antibody did stimulate the production of the effector T cells when the soluble protein was covalently linked to the plasma membrane of BALB/c spleen cells, but not when the idiotype-positive protein was presented on allogeneic C57BL/6 spleen cells. A single exposure of spleen cells to 2C3E1 cells in vivo was sufficient to prime the idiotype-specific T cells, but the frequency and reproducibility of variant selection increased when the in vivo primed effector T cells were restimulated by irradiated 2C3E1 cells in vitro prior to co-cultivation with the wild-type 2C3E1 cells. The initial variant B cell lines could be segregated into several different phenotypes. However, after extensive cultivation either in vitro or after repeated transfer in vivo, all of the variant cell lines acquired a single stable phenotype that was characterized by the loss of both the surface and secreted idiotype marker and antigen-binding activity associated with the wild-type 2C3E1 cells.

Animals↗

Present status of pharyngogastric anastomosis following pharyngolaryngo-oesophagectomy.

Pharyngolaryngo-oesophagectomy with pharyngogastric anastomosis was described more than 25 years ago. Since then it has been employed for the treatment of cancers of the hypopharynx, cervical oesophagus and larynx. Results of recent reports showed a wide variability. Our previous report of 157 such operations gave a significant morbidity and overall hospital mortality rate of 31 per cent. In the 6-year period between 1980 and 1985, 91 patients underwent this operation. The morbidity and mortality rates gradually decreased to 30 and 5 per cent respectively. Changes in the indications for the operation resulted in a reduction in the number of procedures performed in recent years. Resection of the oesophagus for cancers of the pharyngolaryngeal region is indicated only when there is actual oesophageal involvement, and would be the prime indication of pharyngogastric anastomosis.

Esophageal Neoplasms↗

Response of advanced breast cancer to total endocrine ablation after exacerbation on tamoxifen: results in seven patients and possible mechanism of action.

Usage of tamoxifen in the treatment of advanced breast cancer is increasing and is advocated by some authors as primary therapy in all estrogen receptor positive cancer patients. Tamoxifen is an incomplete estrogen antagonist with partial estrogen agonist activity as well. Tamoxifen-induced exacerbation of breast cancer ("tamoxifen flare") is reported to occur in 4-20% or more of treated patients. Management of this condition has varied from stopping treatment to continued administration or reinstitution of tamoxifen after flare symptoms subside. Responses have occurred in some patients so treated, although the remissions do not appear durable. The seven patients with advanced breast cancer in this report experienced disease exacerbation with tamoxifen therapy. Endocrine ablation afforded all patients excellent pain relief and disease control with prolonged survival in six of the seven. There have been no studies directly examining the disease course in flare patients continuing on tamoxifen. Persistence in treating these patients with an incomplete antagonist-agonist may deprive them of full survival benefit possible through ablative procedures when used in sequential treatment.

Adrenalectomy↗

Changes in neurofilament gene expression occur after axotomy of dorsal root ganglion neurons: an in situ hybridization study.

Neurofilaments (NFs) are predominant elements in large myelinated axons, where they are thought to serve the important function of maintaining axonal caliber. Previous studies have shown that changes in NF synthesis and axonal transport occur after axonal injury in rat dorsal root ganglion (DRG) cells. The resulting reduction in the NF supply to DRG axons is thought to be largely responsible for the observed decrease in axonal diameter in the proximal axonal stump after an injury. In the present study, we test the hypothesis that a change in NF gene expression precedes the changes in synthesis and transport of NF proteins. To address this hypothesis, the levels of mRNA encoding the 68-kilodalton (kd) neurofilament protein (NF68) in adult rat DRG neurons were assessed at different times after peripheral axotomy using in situ hybridization. For these studies we used a 35S-labeled cDNA probe to NF68. The levels of NF68 mRNA in sensory neurons located in ipsilateral fourth and fifth lumbar DRG at 1, 7, and 14 days after sciatic nerve crush were compared to those in normal DRG neurons using quantitative autoradiography. In large DRG neurons (greater than 1000 micron 2), the levels of NF68 mRNA were significantly reduced relative to normal at 1, 7, and 14 days after axotomy. Medium-sized cells (601-1000 micron 2) exhibited a reduction only at 14 days postinjury, and small-sized cells were not significantly affected. These findings indicate that larger DRG neurons which give rise to large myelinated sensory axons exhibit a change in NF gene expression after axonal injury. The observed changes in NF68 mRNA levels temporally precede changes in NF synthesis and transport in injured DRG cells. Thus, a change in NF gene expression may be an important component of an effective regenerative response and a critical step at which axonal caliber is regulated in injured neurons.

Animals↗

Esophageal resection for cancer: the rationale of current practice.

The prospects for patients with esophageal cancer treated surgically have improved considerably in recent years. A larger proportion of unselected patients can undergo resection, which now carries an acceptably low mortality rate. Serious complications arising directly from technical failure are minimal but a reduction in the incidence of the most common cause of death, pulmonary infection, and ultimately respiratory failure is not imminent and will require a concerted effort of investigation and modification of treatment strategy to achieve this. Pathologic studies indicate that a subtotal esophagectomy is desirable for all squamous cancers and, if possible, a resection margin of 10 cm should be obtained. The esophagogastric anastomosis made by a circular stapler is a very safe one, although it is associated with a high incidence of anastomotic stricture. Survival rates of resected patients are encouraging. Half of these patients had potentially curative resections and the 3.5 year survival rate was 41.3 percent, whereas for those resected for palliation, it was 7.3 percent. Almost all patients had their ability to swallow restored, which was the primary objective of operation.

Deglutition↗

Surgery during acute pancreatitis. Observations in 50 patients.

Surgery was performed during the acute phase of illness in 50 of 348 patients with acute pancreatitis. The operative mortality was 40 percent. Analysis of the indications for operation, the operative findings, and the mortality rate revealed that the suspected complications for which operation was planned were not always borne out by the operative findings. In addition, the deterioration of patients while being treated conservatively, or the presence of severe acute pancreatitis preoperatively, were not predictive of the finding of hemorrhagic or necrotizing pancreatitis at operation. In a significant proportion of patients with severe pancreatitis, the diagnosis of pancreatitis was first made at laparotomy. More use should be made of the newer investigative methods to better identify any complications which may have occurred and the necessity for operative intervention.

Acute Disease↗

The effects of substance P, histamine and histamine antagonists on somatostatin and gastrin release from the isolated perfused rat stomach.

UNLABELLED: Secretion of somatostatin-like immunoreactivity (SLI) from the isolated perfused rat stomach has been shown to be inhibited by substance P. The present study was initiated to examine the possibility that this action of substance P was mediated via release of histamine. Substance P (1 microM) reduced basal secretion of SLI in agreement with earlier studies. Neither pyrilamine nor cimetidine influenced this action. Basal immunoreactive gastrin (IRG) secretion was unaffected by substance P. Addition of pyrilamine during substance P perfusion increased IRG secretion whereas addition of cimetidine resulted in a delayed decrease on removal of both compounds. Histamine (1 and 10 microM) increased SLI secretion and reduced IRG secretion. Pyrilamine increased and cimetidine decreased IRG secretion but neither drug influenced SLI secretion. Pyrilamine had no effect on histamine-stimulated SLI secretion but inhibition of IRG secretion by histamine was converted to stimulation. Cimetidine potentiated histamine stimulation of SLI secretion and inhibition of IRG secretion. IN CONCLUSION: (1) substance P inhibition of SLI secretion is unlikely to be mediated via release of histamine. (2) The gastrin cell appears to have both H1- and H2-receptors which mediate opposite actions but H1-receptor-mediated inhibition is predominant. (3) Histamine weakly stimulates SLI secretion but there may be both inhibitory and stimulatory pathways acting via H2- and H1-receptors, respectively.

Animals↗

Local recurrences after subtotal esophagectomy for squamous cell carcinoma.

From July 1982 to June 1985, 100 patients with squamous cell carcinoma of the thoracic esophagus had esophageal resection and reconstruction using an abdominal and right thoracotomy approach (Lewis-Tanner operation). Five patients died within 30 days. The remaining 95 patients were studied prospectively for evidence of local recurrences. It was found that anastomotic recurrences occurred in eight patients, and mediastinal recurrences involving the intrathoracic stomach occurred in seven patients over a mean follow-up period of 13 months. The total local recurrence rate was 16% (15 of 95 patients). The incidence of anastomotic recurrence was shown to be related only to the length of the proximal resection margin and not related to tumor differentiation or lymph node metastases. A proximal resection margin of less than 5 cm measured at operation had a 20% risk of developing an anastomotic recurrence, and a margin of between 5 to 10 cm had an 8% risk. Mediastinal recurrences that encroached on the intrathoracic stomach were found to be related more to the extent of lateral spread of the primary tumor in the mediastinum than to the length of the resection margins. Postoperative radiotherapy in patients with palliative resections decreased the incidence of local recurrences. To reduce the incidence and consequences of local recurrence after esophagectomy, it is suggested that in patients with tumors in the upper thorax, a more complete esophagectomy is warranted, postoperative radiotherapy should be given to patients with short resection margins, and in patients with extensive mediastinal spread, use of the retrosternal route for reconstruction is preferred.

Carcinoma, Squamous Cell↗

Towards effective clinical teaching in nursing.

During the last two decades, the structure and function of clinical learning and teaching have undergone significant changes. Nursing students demand quality teaching rather than supervision in the clinical area alone. At the same time, expectations and demands of university nursing faculty also change. Nurse educators are under increasing pressure to engage in scholarly activities. Clinical instruction in baccalaureate nursing programmes becomes the primary responsibility of either the inexperienced or part-time, sessional instructors. This pattern of faculty teaching assignment is not without problems. This paper critically examines these problems and proposes strategies for dealing with them.

Clinical Competence↗

Oestradiol binding activity in rat liver tumours and in human hepatocellular carcinoma.

Oestradiol binding activity was studied in normal liver tissues of rats as well as in experimentally induced liver tumours by incubating a cytosol prepared from the tissue with radioactive oestradiol. The free radioactive hormone was absorbed by a dextran-charcoal suspension, and the amount required to saturate the receptors was calculated by a Scatchard plot. Similar activity was observed in normal human liver as well as naturally occurring hepatocellular carcinoma.

Animals↗

Is pyloroplasty necessary in esophageal replacement by stomach? A prospective, randomized controlled trial.

A randomized, prospective, controlled trial compared the use of pyloroplasty (study group) with nonuse of the procedure (control group) in the treatment of 72 patients with carcinoma of the thoracic esophagus. In these patients, transthoracic esophagectomy was performed, and the whole stomach was used for reconstruction in the right side of the chest. No complications due to the pyloroplasty developed in any of the patients who underwent this procedure. Gastric emptying tests that were performed at the sixth postoperative month in 37 patients demonstrated a prolongation of emptying time in the control group (p less than 0.01). The patients' symptoms, however, did not correlate well with gastric emptying time. Follow-up assessment showed that a higher proportion of patients who did not undergo pyloroplasty suffered from symptoms of incomplete emptying while eating, but the difference was not statistically significant. Moreover, the proportion of patients who were free of postoperative symptoms gradually increased in both groups and reached 100% in the study group and 89% in the control group at 2 years. In the control group, two of the three patients with prolonged gastric emptying time complained of persistent regurgitation and distending discomfort after meals (18 and 24 months after surgery). They were the only two patients who might have benefited from a drainage procedure at the initial operation. Since there apparently were no reliable operative criteria by which to identify patients who might require drainage, and since the risk associated with pyloroplasty was negligible, it would seem reasonable to perform a pyloroplasty on every patient in whom the whole stomach was used for reconstruction after esophagectomy. This procedure would benefit the few patients who might manifest symptomatic gastric stasis.

Adult↗

Esophagogastric anastomosis performed with a stapler: the occurrence of leakage and stricture.

The circular stapler has lowered the leakage rate of an esophageal anastomosis to a level hitherto achieved by only a few surgeons performing hand anastomosis on selected patients with carcinoma of the esophagus. However, the esophageal anastomosis performed with a stapler is also associated with a high stricture rate. Our prospective study was conducted to determine the leakage rate and the incidence of stricture after esophagogastric anastomosis was performed with a stapler, the relationship of stricture to the size of the stapler, and the risk of stricture in relation to time. In a group of 174 patients with carcinoma of the thoracic esophagus, resection was performed, and a one-stage esophagogastric anastomosis was constructed. There were 33 hand anastomoses, 64 anastomoses with an EEA stapler (U.S. Surgical Corp., Norwalk, Conn.), and 77 anastomoses with an ILS stapler (Ethicon Ltd., Edinburgh, U.K.). The anastomotic leakage rate was 3.4% (6/174); 3% with the hand technique and 3.5% with the stapler technique (4.7% for the EEA and 2.6% for the ILS). After leakages and hospital deaths were excluded, 133 discharged patients were evaluated for the occurrence of anastomotic strictures. Only those who complained of dysphagia were investigated. The incidence of stricture for hand anastomosis was 8.7%-EEA 20% and ILS 10%; the overall incidence of anastomoses with a stapler was 14.5%. The true incidence would probably be higher if all patients were assessed by endoscopic or radiologic examination after operation. All three sizes of EEA staplers had a high incidence of stricture. For the ILS stapler the 25 mm size had the highest stricture rate (28.6%) of all groups, but for the 29 and 33 mm sizes, the incidences were 5.3% and 0%, respectively. Actuarial analysis showed an increasing risk of stricture with a reduction in the size of stapler used and was 32.5% and 35%, respectively, for the ILS 25 mm and EEA 25 mm staplers at 131/2 months. The risk of stricture occurrence was highest in the first 4 months. Treatment by bougienage was satisfactory. In conclusion, esophagogastric anastomosis performed with a stapler is a very safe procedure with respect to leakage but is associated with a high risk of stricture, except when the largest ILS staplers are used. However, dilatation readily overcomes the stricture occurrence and adequately compensates for the reduced leakage rate and its attendant serious consequences.

Esophageal Neoplasms↗

Intraoperative flexible choledochoscopy for intrahepatic and extrahepatic biliary calculi.

This prospective study evaluates the use of intraoperative flexible choledochoscopy in the detection and removal of additional stones after conventional bile duct exploration. The biliary system of 109 patients was examined with an Olympus CHF-B4 choledochoscope after conventional methods of exploration. Sixty-five patients had only common duct stones and 44 patients had intrahepatic stones with or without stones in the common duct. Additional stones were detected in 11 patients (16.9%) in the group with common duct stones; eight of these patients had their stones completely removed. Unsuspected residual stones were discovered by means of postoperative cholangiography in three more patients (4.6%); thus the total number of patients with residual stones was six (9.2%). Additional stones were detected in 39 patients (88.6%) in the group with intrahepatic stones. Of these, only 13 patients managed to be freed of stones with the use of the choledochoscope. A further 10 patients underwent liver resection to achieve stone clearance. Unsuspected retained stones were found postoperatively in seven of the 28 patients (25%) whose biliary systems were considered clear of stones. The overall number of patients with retained stones in the group with intrahepatic stones was 23 (52.3%). We concluded that intraoperative flexible choledochoscopy is useful in detecting intrahepatic stones left behind after conventional exploration. However, complete removal of the stones is difficult to achieve.

Adult↗

Stapled esophagogastric anastomosis in the apex of the right chest after subtotal esophagectomy for carcinoma.

Using the abdominal-right chest approach for subtotal esophagectomy of carcinoma of the thoracic esophagus by creating an anastomosis in the apex of the chest with a circular stapler, we have found the technique to be expeditious, tidy and safe. Anastomotic leakage occurred in only one of 108 operations. The site of the anastomosis is as high as, if not higher, than the usual three phase esophagectomy with cervical anastomosis, thus demonstrating that subtotal esophagectomy has been achieved. Technical details are quite important for the success of this operation and the method described herein has been shown to be satisfactory.

Esophageal Neoplasms↗