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The enzyme catechol-O-methyltransferase (COMT), which plays an important role for dopamine metabolism, is abundantly expressed in the kidney. To test whether the natriuretic effects of dopamine may be related to the rate of dopamine metabolism, rats were treated with nitecapone, a peripheral inhibitor of COMT. Nitecapone, given by gavage, induced a highly significant (5.6-fold) increase in sodium excretion, which was associated with an inhibition of the Na+,K+-ATPase activity in both the proximal convoluted and proximal straight tubules (PCT and PST, respectively). These effects were completely abolished if the rats were also treated with a specific dopamine 1 antagonist, SCH 23390. Furthermore, the natriuretic effect of nitecapone was also observed in rats on a high salt diet. The kidney-specific pro-drug to dopamine, glu-dopa, induced a significant, but less pronounced increase in urinary sodium excretion, associated with a dopamine-dependent inhibition of the Na+,K+-ATPase activity in the PCT but not in the PST. Nitecapone and glu-dopa had an additive natriuretic effect. It is concluded that COMT plays an important role in determining the natriuretic effects of the renal dopamine system.

The prognosis among patients diagnosed with oesophageal cancer is poor with an overall 5-year survival close to 5% in most countries. Improved diagnostic and surgical strategies might influence the survival, however. We investigated the observed and relative survival among all patients in Sweden diagnosed with oesophageal adenocarcinoma (n ‫؍‬ 1,441) or squamous cell carcinoma (n ‫؍‬ 6395) from 1961-1996 with follow-up to December 1997. Observed survival rates were calculated by the life-table method. Relative survival rates were computed as the ratio of the observed to the expected survival. The expected survival was inferred from the survival among the entire Swedish population in the same age, sex and calendar year strata. The 5-year observed survival rate for adenocarcinoma increased from a stable figure close to 4% during the entire period 1961-1989 to 10.5% during 1990 -1996. Similarly, the 5-year relative survival rate was stable around 5% during 1961-1989, but during 1990 -1996 the survival was increased to 13.7%. For squamous cell carcinoma, the survival improved slightly by each decade, starting with 3.8% 5-year observed survival in 1961-1969 to 7.0% during 1990 -1996. Similarly, the 5-year relative survival improved from 5.0% to 8.9% during the study period. In conclusion, the survival rates for both oesophageal adenocarcinoma and squamous cell carcinoma have increased significantly during the 1990s compared to those in the previous 3 decades (p < 0.001). © 2002 Wiley-Liss, Inc. Key words: oesophageal cancer; survival; mortality; neoplasm; oesophagus; SwedenOesophageal cancer is a highly lethal malignancy. The previously reported 5-year survival rate of close to 5% for both histologic types, i.e., adenocarcinoma and squamous cell carcinoma, is worse than that of most other malignancies. 1 Surgical resection is the only established curative treatment for oesophageal cancer. Several randomised clinical trials trying adjuvant therapy have been conducted, but the results have generally been disappointing. There is currently no evidence of an increased long-term survival as a result of the use of adjuvant chemotherapy or radiotherapy. 2,3 In recent decades there has been a rapid increase in the incidence of oesophageal adenocarcinoma in Western countries, whereas the incidence of squamous cell carcinoma of the oesophagus has been stable or decreasing. 4,5 Most oesophageal adenocarcinomas develop from BarrettЈs oesophagus, a columnar cell metaplasia of the native distal oesophageal squamous cell mucosa, easily detectable at endoscopy and verified by histology. 6 The strong association with oesophageal adenocarcinoma has prompted calls for introduction of endoscopic surveillance programs for early detection of adenocarcinoma among persons with BarrettЈs oesophagus, 7 although cost-effectiveness should be taken into account. 8

Palliation of malignant dysphagia with self-expanding metal stents is safe and confers almost immediate improvement of dysphagia in the majority of patients. Tumour-related and demographic factors do not seem to influence the outcome.

BackgroundSecuring high-quality mortality statistics requires systematic evaluation of all trauma deaths. We examined the proportion of trauma patients dying within 30 days from causes not related to the injury and the impact of exclusion of patients dead on arrival on 30-day trauma mortality. We also defined the demographics, injury characteristics, cause of death and time to death in patients admitted to our trauma center who died within 30 days, between 2007-2011.MethodsDemographics, injury characteristics, status alive/dead on arrival, cause of death and time to death of all patients were reviewed. Deaths were analyzed based on injury mechanism (penetrating, blunt trauma and low energy blunt trauma) and cause of death (traumatic brain injury (TBI), hemorrhage, organ dysfunction and other/unknown).ResultsOf the 7422 admissions, 343 deaths were identified of which 36 (10.5%) involved causes not related to the injury. The overall age was 71 years, Injury Severity Score (ISS) 29 and time to death 24 hours (all medians). Fifty-four patients (17.6%) were dead on arrival. Exclusion of patients dead on arrival reduced the overall mortality rate (P < 0.05) and median ISS (P < 0.05) and increased median age (P < 0.01) and time to death (P < 0.001). Injury mechanism was penetrating trauma in 7.5%, blunt trauma in 56.0%, and low energy blunt trauma in 36.5%. TBI accounted for 58.6%; hemorrhage 16.3%, organ dysfunction 15.0%, and other/unknown for 10.1% of the deaths. Patients who died after low energy blunt trauma were older, had lower ISS and longer time to death compared to those who died after penetrating and blunt trauma (all P < 0.01).ConclusionsClinical review of all trauma deaths was essential to interpret mortality. Thirty-day trauma mortality included 10.5% deaths not directly related to the injury and the exclusion of patients dead on arrival significantly affected the unadjusted mortality rate, ISS, median age and time to death.

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Patients with esophageal cancer have a modestly poorer prognosis when operated on at low-volume centers or by surgeons with less experience with esophageal cancer surgery.