纤维结肠镜检查大肠息肉与肿瘤122例分析

息肉与大肠癌在大肠疾病中均占有重要地位,纤维结肠镜(纤肠镜)检查息肉发现率为16.4～41.5%,大肠癌(直、结肠)发现率为6.9～10.7%。息肉与癌关系密切,25%的大肠癌同时伴有息肉存     

老年人大肠腺瘤的临床与病理学特点

目的　探讨老年人大肠腺瘤的临床及病理学特点 ,提高大肠癌的Ⅱ级预防水平。方法　总结 767例大肠腺瘤患者结肠镜 5～ 1 7年跟踪随访结果。结果　 50岁以后大肠腺瘤患病率随增龄而增加 ,患病高峰年龄为 70～ 79岁组 (42 5 % ) ,60～ 69岁组次之 (2 6 9% )。初诊与随访中管状腺瘤所占比例最高 (78 0 %和 82 6 % ) ,混合性腺瘤占 1 4 6 %和 1 2 1 % ,绒毛状腺瘤最少 (7 4%和 5 3 % )。 80 7%和 84 6 %的腺瘤均≤ 5mm。发生异型增生、癌变的腺瘤中 ,72 6 %和 73 1 %的腺瘤均 >1 0mm ,而 63 7%和 61 5 %均呈绒毛状腺瘤。腺瘤的癌变率为 4 8%。结论　大肠腺瘤是老年人的常见病 ,绝大多数腺瘤呈良性过程 ,但需定期在肠镜的监测下及时处理腺瘤 ,可预访大肠癌的发生     

结肠镜检查中大肠腺瘤的漏诊率及漏诊相关危险因素

目的 明确结肠镜检查中大肠腺瘤的漏诊率及漏诊腺瘤特征,探讨腺瘤漏诊的相关危险因素.方法 患者在初次结肠镜检查发现并切除腺瘤后120 d内进行结肠镜复查,分析2次结肠镜检查结果.记录2次结肠镜检查所见腺瘤的特征(包括大小、部位、形态、数目及病理)、患者临床特征(包括年龄、性别、结肠镜检查原因、腹部及盆腔手术史、大肠憩室病史及是否行无痛结肠镜检查)及不同的内镜操作医师.分析不同类型腺瘤在结肠镜检查中的漏诊率以及腺瘤特征、患者临床特征和内镜医师的操作水平对腺瘤漏诊的影响.结果 809例患者中271例发生腺瘤漏诊,2次结肠镜检查共检出腺瘤2134颗,漏诊腺瘤425颗,腺瘤总漏诊率为20%(425/2134);平均患者腺瘤漏诊率为33%(271/809).腺瘤体积大者,漏诊率低(P<0.01);乙状结肠、肝曲、盲肠和升结肠部位的腺瘤以及平坦型腺瘤容易漏诊(P<0.05);患者腺瘤数越多在结肠镜检查中腺瘤漏诊率越高(P<0.01);初级内镜医师与有经验内镜医师相比,其漏诊率明显增加(P<0.01).结论 结肠镜检查中存在部分腺瘤漏诊,腺瘤漏诊与腺瘤大小、形态、部位、数目以及结肠镜检查操作医师密切相关.     

结肠镜检查中大肠腺瘤的漏诊率及漏诊相关危险因素

目的 明确结肠镜检查中大肠腺瘤的漏诊率及漏诊腺瘤特征,探讨腺瘤漏诊的相关危险因素.方法 患者在初次结肠镜检查发现并切除腺瘤后120 d内进行结肠镜复查,分析2次结肠镜检查结果.记录2次结肠镜检查所见腺瘤的特征(包括大小、部位、形态、数目及病理)、患者临床特征(包括年龄、性别、结肠镜检查原因、腹部及盆腔手术史、大肠憩室病史及是否行无痛结肠镜检查)及不同的内镜操作医师.分析不同类型腺瘤在结肠镜检查中的漏诊率以及腺瘤特征、患者临床特征和内镜医师的操作水平对腺瘤漏诊的影响.结果 809例患者中271例发生腺瘤漏诊,2次结肠镜检查共检出腺瘤2134颗,漏诊腺瘤425颗,腺瘤总漏诊率为20%(425/2134);平均患者腺瘤漏诊率为33%(271/809).腺瘤体积大者,漏诊率低(P<0.01);乙状结肠、肝曲、盲肠和升结肠部位的腺瘤以及平坦型腺瘤容易漏诊(P<0.05);患者腺瘤数越多在结肠镜检查中腺瘤漏诊率越高(P<0.01);初级内镜医师与有经验内镜医师相比,其漏诊率明显增加(P<0.01).结论 结肠镜检查中存在部分腺瘤漏诊,腺瘤漏诊与腺瘤大小、形态、部位、数目以及结肠镜检查操作医师密切相关.     

256例大肠异常隐窝灶的内镜与病理特征分析

目的了解大肠异常隐窝灶的内镜和病理特点,探讨ACF与结直肠肿瘤的关系。方法随机选择2011年8月-2012年3月就诊于江西省萍乡市人民医院准备接受结肠镜检查的患者370例,在距肛门25～30 cm以下给予0.4%靛胭脂染色后观察、记录发现远端大肠ACF病例数及ACF数目,并且行病理检查。结果 370例患者共发现256例ACF病例(69.19%)。正常黏膜组、增生性息肉组、腺瘤组、结肠癌组ACF患病率分别为58.21%、78.18%、82.05%、88.89%。256例ACF患者Ⅰ级106例(41.41%)、Ⅱ级82例(32.03%)、Ⅲ级68例(26.56%)。病理有异型增生病例数39例(10.54%),均为轻度异型增生;病理无异型增生217例(58.65%)。有ACF组增生性息肉的发生率为16.8%,腺瘤的发生率25.0%,结直肠癌的发生率12.5%;而无ACF组分别为10.53%、12.58%、3.51%。结论异常隐窝灶是常见结肠镜下病变,异型增生ACF病变并不少见。ACF可能是结肠腺瘤和大肠癌的独立预测因素。     

结肠镜对诊断大肠多原发癌的作用

大肠多原发癌和腺瘤是引起大肠癌术后复发的重要原因。大肠癌术前全结肠的肠镜检查、术后的肠镜随访、肠镜下积极治疗癌前病变——大肠腺癌,是提高大肠多原发癌的诊断和降低发生率的重要手段。 临床资料 1973～1991年共行结肠镜检查2600例,发现大肠癌163例(6.3％),其中大肠多原发癌22例(13.5％)。男13例,女9例。年龄18～20岁3例,29     

大肠癌早期诊断与治疗存在的几个问题与对策

经典的大肠隆起性肿瘤临床易发现,随着肠镜普及应用不易漏诊,但在我国绝大部分大肠癌在发现时已近中晚期,5年生存率在30%～60%之间.而影响大肠癌患者早期诊断的原因很多,综合起来有如下几点：（1）高危人群的筛检;（2）患者能否有意识地在无症状期接受肠镜检查;（3）内镜医师能否恰当地使用内镜将大肠早期癌以及癌前病变准确的检出而不漏诊,尤其是对患者危害甚大但又易漏诊的大肠平坦型肿瘤;（4）病理医师是否能选择恰当手段将全瘤中某一点已经发生或可能发生癌变的部分准确检出而不漏诊.     

大肠肿瘤机会性筛查初探

目的初步探讨大肠肿瘤机会性筛查的临床应用价值。方法采用问卷调查、粪隐血试验、结肠镜检查的方法,统计分析2011年11月-2012年8月到我院消化门诊就诊患者行大肠肿瘤机会性筛查情况。结果共573例最终进入筛查,其中148例通过宣传教育后进入筛查队伍,占筛查人群的25.83%(148/573),粪隐血试验依从性为80.45%(461/573),阳性率为6.07%(28/461);结肠镜检查的依从性为90.05%(516/573)。粪隐血试验阳性人群接受结肠镜检查的依从性为92.86%(26/28);结肠镜检出大肠肿瘤共194例,检出率为37.60%(194/516),其中检出大肠癌共25例,检出率为4.84%(25/516)。结论机会性筛查人群依从性高,可以更多地检出大肠癌和癌前疾病,医师的推荐是影响筛查依从性的重要因素,开展机会性筛查是一个值得探索的适合国情的大肠肿瘤筛查模式。     

272例老年人结肠镜检查随访分析

老年人是大肠疾病尤其是大肠肿瘤的高发人群，结肠镜检查是检出大肠疾病的有效手段。我们对272名老年人结肠镜检查随访分析，表明结肠镜检查在老年人大肠疾病的诊治中的重要作用。 1.资料和方法：对象为272名在3～10年前曾做过至少一次结肠镜检查的老年人，做结肠镜复查；男181名，女91名；年龄60～84岁，平均67.2岁。随访时间3～10年，平均5.1年；接受检查次数2～5次，平均2.7次。同时对45名无下消化道症状、从未做过结肠镜检查的老年人(平均65.6岁)首次结肠镜检查的结果作为对照。     

结肠镜下高频电切息肉的护理配合

大肠息肉是目前国内外公认的大肠癌癌前期病变。高频电切息肉是目前治疗大肠息肉的主要手段之一。我院自1988年12月至1996年2月共行结肠镜下高频电切大肠息肉805例1476颗。现将术中的护理配合报告如下。一、临床资料本组病例男480例,女325例,年龄2～79岁,其中2～8岁62例;有蒂息肉(含亚蒂)389     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.