大肠癌APE1的表达特点及临床意义

目的 探讨脱嘌呤／脱嘧啶核酸内切酶（APE1）在大肠癌发生、发展中的作用。方法 应用免疫组化SP法检测125例大肠癌、72例大肠腺瘤、60例癌旁大肠黏膜和40例正常大肠黏膜中APE1的表达情况，并分析APE1与大肠癌临床病理之间的关系。结果 正常大肠黏膜APE1呈胞核表达，大肠腺瘤和大肠癌组织APE1表达特征发生改变，呈胞核表达、单纯胞质表达或核浆共同表达。APE1胞质异位表达率大肠癌组织为73．6％，大肠腺瘤组织为83．3％，二者无显著性差异（P〉0．05），但均显著高于癌旁大肠黏膜（10％）和正常大肠黏膜（0％，P〈0．01）。APE1胞质异位表达与大肠癌临床分期和淋巴结转移有关（P〈0．01，P〈0．05）。结论 APE1胞质异位表达可能在大肠癌的发生、发展中起重要作用。     

遗传性非息肉病性大肠癌的临床研究进展

遗传性非息肉病性大肠癌（hereditary nonpolyposis colorectal cancer,HNPCC）又称Lynch综合征,是一种由错配修复基因（mismatch repair gene,MMR）突变引起的常染色体显性遗传病。作为大肠癌的一个重要临床亚型,HNPCC约占全部大肠癌的5%～15%。相对于散发性大肠癌,HNPCC的遗传病因特殊、临床病理特点突出,是目前大肠癌和遗传性肿瘤的一个研究热点。     

550例大肠息肉的临床病理分析、内镜下治疗及随访

本文报道５５０ 例大肠息肉的临床及病理特点、内镜下治疗及１～２０ 年随访结果。大肠息肉的检出率为１４．０％ ，５０ 岁以上患者占 ４９．１％ ，单发性息肉 ４２０ 例，多发性息肉 １３０ 例，好发部位为乙状结肠和直肠（５０．５％ ）。病理诊断以腺瘤性息肉（４２．２％ ）和炎性息肉（４０．０４％ ）最多，息肉的异型增生发生率为１４．２％ ，腺瘤性息肉的癌变率为 １２．１％ ，结肠癌伴息肉的发生率为 ２．９％ 。对５４４ 例患者进行了内镜下息肉治疗，息肉的复发及再发率为５５．４％ ，平均复发时间为 ３２ 个月。随访检出４ 例息肉癌变，分别在术后第 ３、５、１０、２０ 年。     

下消化道出血171例病因分析

目的探讨下消化道出血的病因及其年龄、性别分布特点。方法对171例下消化道出血怠者的纤维结肠镜检查结果进行分析。结果下消化道出血的病因依次为溃疡性结肠炎（29．2％），大肠癌（17．0％），内痔（13．5％），结肠炎（12．9％），大肠息肉（10．5％）。结、直肠癌在中年组和老年组明显高于青年组；青年组中以溃疡性结肠炎最为多见。男性患者中内痔的比例明显高于女性患者。结论下消化道出血常见病因包括溃疡性结肠炎、大肠癌、内痔、结肠炎和大肠息肉等疾病。不同年龄组和性别间病因分布不同。     

大肠癌及各类型大肠息肉流式细胞DNA定量研究

大肠息肉是一种常见的良性肿瘤，其中腺瘤性息肉与大肠癌的发生有密切关系［１］。本文应用流式细胞计对不同病理类型的大肠息肉组织细胞ＤＮＡ定量分析，探讨各类息肉尤其是腺瘤性息肉由轻度到重度异型增生，及大肠癌不同阶段组织细胞ＤＮＡ含量的变化规律，为临床正确处理各类型息肉提供理论依据。１　材料和方法１．１　材料来源：６５例标本均为内窥镜下活检组织，其中正常大肠粘膜６例，炎性息肉１０例，增生性息肉７例，腺瘤性息肉１０例，腺瘤性息肉伴轻度异型增生的１０例，伴中重度异型增生１２例，大肠癌１０例。１．２　方法：标…     

粪便中检测K-ras基因突变对老年大肠癌诊断价值的研究

探讨粪便K-ras基因检测在老年大肠癌临床诊断中的价值。收集连续就诊的23例老年大肠癌患者，20例结肠癌瘤性息肉患者及20名健康老年查体者的粪便，并从中提取DNA，应用等位基因特异性杂交技术检测粪便K-ras基因第12位密码子第1，2位碱基突变情况。结果K-ras基因突变在大肠癌患者为56．52％（13／23），明显高于正常查体者的5％（1／20）（P＜0．01），与结肠腺瘤性息肉组的30％（6／20）比较，差异无显著性意义（P＞0．05）。92．31％（12／13）的大肠癌K-ras基因突变位点发生在第12位密码子第2位碱基。研究表明，结肠癌患者组织及粪便中K-ras基因突变的检出具有良好的一致性，提示粪便中检测K-ras基因突变是一种无创性的老年大肠癌的诊断方法。     

家族性大肠息肉症（附5例报告）

家族性大肠息肉症（附５例报告）内蒙呼和浩特市第一医院放射科章强，尚来焕内蒙呼和浩特市第一医院外科王焕仁，王风英家族性大肠息肉症（Ｆａｍｉｌｉａｌｐｏｌｙｐｏｓｉｓｃｏｌｉ）是以大肠多发性腺瘤性息肉为基本特征，并有明显遗传性和很高恶变率的一种少见消化道...     

抗细胞角蛋白单克隆抗体AE1／AE3在食管,贲门,胃和大肠…

应用抗细胞角收白单克隆抗体ＡＥ１／ＡＥ３，对食管癌、胃癌和大肠癌的原发组织反应进行了研究。结果表明，４６例癌组织的反应率是９３％，食管癌为１００％，胃癌和大肠癌分别是９４％和７９％；反应强度和反应范围显示，食管癌较胃和大肠癌好。ＡＥ１／ＡＥ３符合做检测食管癌在非上皮组织（淋巴结、骨髓和外周血）中的微小转移的探针，不宜用来检测胃和大肠癌的微小转移，至少不能单独使用。同为胃和大肠来源的腺癌组织可出现阴     

幽门螺杆菌感染与胃息肉关系探讨

目的：探讨不同类型胃息肉与幽门螺杆菌感染的关系。方法；经胃镜活检及病理诊断胃息肉106例，内镜下除的胃息肉作HE染色，判定胃秘肉组织学类型及炎症反应程度。同时在胃窦部取材2－3块，分别作快速尿毒酶试验及美蓝染色，以检测Hp感染率，两均阳性判为Hp感染。结果：106例胃息肉Hp总检出率为65．1％。胃息肉以增生息肉多见，共76例，占71．7％，腺瘤性息肉30例，占28．3％。Hp感染率在增生性息肉中为73．7％（56／76），显高于腺瘤性息肉43．1％（13／30）（P＜0．01）。活动性炎症在增生性息肉中为55．3％（42／76），显高于腺瘤性息肉30％（9／30）（P＞0．05）。结论：增生性息肉的发生可能与Hp感染有关，这可能与Hp引起胃粘膜活动性炎症反应有关。     

肝动脉化疗栓塞治疗原发性肝癌合并门静脉癌栓疗效分析

目的：探讨肝动脉化疗栓塞术治疗原发性肝癌合并门静脉癌栓的疗效。方法：癌栓组为无手术指征的原发性肝癌合并门静脉癌栓患者50例，对照组为原发性肝癌42例，两组患者均行肝动脉化疗栓塞术（TACE）治疗，观察两组患者的疗效、生存率和并发症。结果：对照组和癌栓组近期总有效率分别为50．0％（21／42）和42．0％（21／50），组间比较无显著差异；癌栓组门静脉癌栓消失或缩小〉25％者为44％（22／50），两组治疗后肝癌二期手术切除率分别为38．1％（16／42）和30％（15／50），无显著差异；对照组0．5、1、2年生存率分别为71．4％（30／42）、47．6％（20／42）、31．0％（13／42），中位生存期为15．6个月；癌栓组分别为64．0％（32／50）、40．0%（20／50）、24．0％（12／50），中位生存期为14．2个月，组间差异不显著；两组患者术后并发症发生率无显著差异。结论：肝动脉化疗栓塞术治疗原发性肝癌合并门静脉癌栓具有较好疗效。     

Is there a role for (99m)Tc-anti-CEA monoclonal antibody imaging in the diagnosis of recurrent colorectal carcinoma?

AIM: To evaluate the usefulness of immunoscintigraphy with an anti-CEA monoclonal antibody fragment labelled with (99m)Tc for early detection of colorectal recurrence in patients with rising serum CEA levels. METHODS: Fifty-one consecutive patients (27 women, 24 men) with colorectal cancer (mean age 68.9+/-10.2 years) and rising CEA levels (16.2+/-18.2 ng/ml) were prospectively studied. Two immunoscintigraphy studies were performed in 8 patients (n=59). Immunoscintigraphy was performed after i.v. injection of 925 MBq of anti-CEA monoclonal antibody. Planar images of the thorax, abdomen and pelvis, as well as SPECT of the abdomen and pelvis were obtained at 4 and 24 hours after injection. In all cases an abdominal CT scan was previously performed. Findings were validated by histopathological analysis (28 cases) or by imaging and clinical follow-up of at least 6 months following the immunoscintigraphy (31 cases). RESULTS: Forty-one patients did not show recurrence during follow-up. We found 18 cases with confirmed diagnosis of extrahepatic abdominal or pelvic diseases, 11 cases with liver metastases, 9 in the thorax and 2 in the bone. In patients with pelvic and extrahepatic abdominal disease, immunoscintigraphy was positive in 18 cases (14 true positive, 4 false positive). From the 14 true positive only 7 cases had been detected by CT. Immunoscintigraphy was negative in the remaining 41 cases (37 true negative, 4 false negative). Therefore, the sensitivity and specificity for immunoscintigraphy in extrahepatic abdominal and pelvic disease were 78% and 90%, respectively. CT results showed a lower sensitivity of 61% (p<0.05) and specificity of 83%. Liver metastases were detected by CT in 9 cases, but only 2 of these were identified using immunoscintigraphy. CONCLUSION: Scintigraphy with anti-CEA monoclonal antibody fragment labelled with (99m)Tc is superior to CT for the detection of pelvic and extrahepatic abdominal recurrence of colorectal cancer, while CT is more sensitive in the detection of liver and lung metastases. Immunoscintigraphy has a limited usefulness in the detection of distant metastases, but it may be helpful in the diagnosis of suspected colorectal recurrence in patients with non-conclusive CT findings, when FDG-PET is not available.     

Investigation of G2-phase chromosomal radiosensitivity in hereditary non-polyposis colorectal cancer cells

Purpose : To investigate whether cells from hereditary nonpolyposis colorectal cancer (HNPCC) patients, a genetic condition characterized by constitutional mutations in DNA mismatch repair genes and associated with predisposition to colorectal carcinoma (CRC), could present a higher G2 chromosomal radiosensitivity. It is generally hypothesized that cancer predisposition in HNPCC is associated with the loss of the wild-type allele in somatic cells, resulting in defective DNA mismatch repair but, to date, no data on G2 radiosensitivity have been reported for HNPCC. Materials and methods : Lymphoblastoid cell lines derived from six HNPCC patients heterozygous for MLH1, one HNPCC patient carrying a mutant MSH2 allele and three healthy controls were treated with 50 cGy of X-rays and sampled at various harvesting times, monitoring cell-cycle progression by 5-bromo-2-deoxyuridine (BrdUrd) incorporation in order to analyse chromosomal damage in the homogeneous G2 population. Results : There were no differences between lymphoblasts derived from patients in the frequency of G2 chromosomal aberrations induced by X-rays when compared with control cell lines. However, despite the absence of G2 radiosensitivity in HNPCC cells, lymphoblasts from patients heterozygous for MLH1 mutations showed a higher induction of chromatid exchanges. Conclusions : The observed possible incorrect rejoining of double-strand breaks in MLH1 heterozygotes would be an additional and important factor contributing to loss of heterozygosity in HNPCC patients.     

Investigation of G2-phase chromosomal radiosensitivity in hereditary non-polyposis colorectal cancer cells.

PURPOSE: To investigate whether cells from hereditary nonpolyposis colorectal cancer (HNPCC) patients, a genetic condition characterized by constitutional mutations in DNA mismatch repair genes and associated with predisposition to colorectal carcinoma (CRC), could present a higher G2 chromosomal radiosensitivity. It is generally hypothesized that cancer predisposition in HNPCC is associated with the loss of the wild-type allele in somatic cells, resulting in defective DNA mismatch repair but, to date, no data on G2 radiosensitivity have been reported for HNPCC. MATERIALS AND METHODS: Lymphoblastoid cell lines derived from six HNPCC patients heterozygous for MLH1, one HNPCC patient carrying a mutant MSH2 allele and three healthy controls were treated with 50 cGy of X-rays and sampled at various harvesting times, monitoring cell-cycle progression by 5-bromo-2-deoxyuridine (BrdUrd) incorporation in order to analyse chromosomal damage in the homogeneous G2 population. RESULTS: There were no differences between lymphoblasts derived from patients in the frequency of G2 chromosomal aberrations induced by X-rays when compared with control cell lines. However, despite the absence of G2 radiosensitivity in HNPCC cells, lymphoblasts from patients heterozygous for MLH1 mutations showed a higher induction of chromatid exchanges. CONCLUSIONS: The observed possible incorrect rejoining of double-strand breaks in MLH1 heterozygotes would be an additional and important factor contributing to loss of heterozygosity in HNPCC patients.     

Inclusion of computed tomographic colonography on pre-operative CT for patients with colorectal cancer

Objectives

To evaluate the impact of the inclusion of computed tomographic colonography (CTC) involving faecal tagging and no laxatives on the computed tomography (CT) study routinely used in staging patients with colorectal cancer.

Methods

CTC was performed on 25 patients who had a diagnosis of colorectal carcinoma, with pathological correlation. Researchers recorded the accuracy of the CTC for staging colorectal cancer, as well as any changes to the plans for surgery based on this exam. The patients’ tolerance of the preparation required and the quality of the exams was also evaluated.

Results

All exams were well-tolerated, and only one had unsatisfactory quality. CTC identified all the carcinomas and had an overall accuracy of 80%, 60.1% and 100% for the evaluation of tumour depth, lymph nodes and metastases respectively. CTC identified all polyps greater than 9 mm. Following CTC, changes to surgical plans were observed in 20.8% of the cases, all with incomplete optical colonoscopies.

Conclusions

CTC proved useful for the pre-operative evaluation of patients with a diagnosis of colorectal carcinoma, affecting plans for surgery in a expressive number of patients with an incomplete colonoscopy.     

结肠,直肠癌APC和MCC基因的分子病理学研究

用ＰＣ技术对２２例结肠、直肠癌标本检测ＡＰＣ和ＭＣＣ基因杂合子的丢失。结果显示：ＡＰＣ基因第１１外显子有９例为纯合子，１３例为杂合子，后者有３例杂合子丢失，占２３．１％；ＭＣＣ基因第１０外显子有８例为纯合子，１４例为杂合子，后者有４例杂合子丢失、占２８．６％。     

OXA-LV-5-FU方案治疗晚期结直肠癌的疗效评价

目的分析奥沙利铂联合亚叶酸钙、5氟尿嘧啶(OXA-LV-5-FU)方案治疗结直肠癌的近期疗效与耐受性。方法奥沙利铂(OXA)100 mg/m2,静脉滴注2 h,第1天;亚叶酸钙(LV)200 mg/m2,静脉滴注2 h后推注5-氟尿嘧啶(5-Fu)400 mg/m2,后续5-Fu 500 mg/m2,静脉持续输注22 h,第1~5天。每4周重复,中位治疗周期为4周期。结果入组观察65例结直肠癌患者,部分缓解(PR)17例,稳定(SD)31例,进展(PD)17例,总有效率(PR)为26.2%(17/65),临床受益率(CR+PR+SD)为73.8%(48/65)。其中初治患者有效率(RR)为32.3%(10/31),复治患者有效率为20.6%(7/34),稳定率为47.7%(31/65)。中位生存时间(MST)为14个月,中位进展时间(MTTP)为9个月。主要毒性反应表现为口腔炎、恶心呕吐和白细胞下降,Ⅲ度以上毒性反应分别为10.8%、12.3%和6.2%。80%的患者有脱发,但无Ⅲ度以上脱发。结论OXA-LV-5-Fu方案治疗晚期结直肠癌疗效较高,不良反应轻而且安全,毒性反应小,明显改善生活质量。     

Extracolonic findings in patients undergoing abdomino-pelvic CT for suspected colorectal carcinoma in the frail and disabled patient

AIM: The aims of this study were to evaluate the extracolonic findings identified in patients undergoing minimal preparation abdomino-pelvic CT in place of barium enema or colonoscopy for the detection of possible colorectal carcinoma. MATERIALS AND METHODS: The CT technique involved helical acquisition (10 mm collimation, 1.5 pitch) following 2 days of preparation with oral contrast medium only. Extracolonic findings were evaluated in the light of subsequent follow-up and accuracy. The evaluation included assessment of the potential contribution of the extracolonic finding(s) to staging the cancer in the subset of patients who had colorectal carcinoma, and to account for the patients' presenting symptoms and signs in the remaining patients. RESULTS: A total of 344 extracolonic findings were detected in 261 CT examinations, from amongst a total of 1077 cases (24%). Extracolonic findings were potentially important in staging in 32 of the 98 (33%) cases subsequently found to have colorectal cancer. There were 284 extracolonic findings amongst the 221 cases who proved not have colorectal cancer. One hundred and twenty-four (44%) of these 284 findings were actively followed up by clinicians, and 33 (12%) ultimately had a surgical intervention. Fifty-six percent (160/284) of the findings were determined to be correct (by further investigation, autopsy, and/or clinical follow-up); the remainder were incorrect or indeterminate (n = 56) or had no follow-up (n = 68). The commonest extracolonic findings were focal liver lesions (found in 42/1077, 4%) and abdominal aortic aneurysms (31/1077, 3%). Twenty-four (24/1077, 2%) previously unknown extracolonic malignancies were detected. Ten percent (106/1077) of the patients had extracolonic findings that could potentially have accounted for their presenting symptoms. CONCLUSIONS: CT has the added benefit, compared with colonoscopy and barium enema, of not just evaluating the colon but also of detecting extracolonic abnormalities. Such findings may be useful in staging the cancer, may explain the patient's presenting symptoms, and may detect other potentially serious disorders.     

α-连接蛋白的表达与大肠癌病理类型、临床分期的关系

目的　探讨α 连接蛋白 (α catenin ,α cat)在大肠癌中的表达与其病理类型、临床分期的关系。方法　采用免疫组织化学的方法研究 8例正常大肠粘膜上皮组织、10 5例原发性大肠癌组织标本α cat的表达情况。结果　α cat在正常大肠粘膜上皮组织均表达保留 ;而在大肠癌标本中的表达保留率只有 40 0 % (4 2 / 10 5 ) ,表达减弱率达 6 0 0 % (6 3/ 10 5 ) ,且与患者年龄、病理组织学分化程度、临床Dukes分期等有显著的相关性 ;但与肿瘤组织的大小无关。结论　α cat的表达减弱与大肠癌的临床病理因素关系较密切 ,可作为了解肿瘤转移的一个较好指标。     

大肠癌组织Fas抗原和p53蛋白的表达及临床意义

目的　探讨大肠癌组织Fas抗原及 p5 3蛋白的表达及临床意义。 方法　采用免疫组织化学方法对 32例大肠癌组织的Fas抗原 ,16例正常大肠组织及 p5 3蛋白表达进行检测和比较。 结果　Fas抗原在正常大肠组织中表达阳性 ,p5 3蛋白在正常大肠组织中表达阴性 ,Fas抗原在大肠癌组织中表达阳性率为 4 0 .6 2 %(13/ 32 ) ,p5 3蛋白在大肠癌组织中的表达阳性率为 5 3.13%。Fas抗原及 p5 3蛋白在大肠癌组织中的表达与患者性别、年龄、肿瘤大小、部位、大体分型、浸润深度、Ducks及局部淋巴结转移等无明显关系 (P >0 .0 5 ) ,Fas抗原在大肠癌组织明显下降 ,Fas抗原表达与大肠癌组织学类型及肝转移相关 (P <0 .0 5 )。p5 3蛋白表达与大肠癌肝转移相关 (P <0 .0 5 )。结论　Fas抗原在大肠癌组织中表达明显下降。随着肿瘤恶性程度的提高 ,Fas抗原表达减少。在肝转移患者中未见表达。p5 3蛋白在大肠癌组织中表达阳性 ,尤以发生肝转移者为著。Fas抗原表达下降或缺乏及 p5 3蛋白过度表达均提示预后不良     

Tumor scintigraphy with 131I anti CEA monoclonal antibodies and F(ab')2 in colorectal cancer

In 14 patients with proven local recurrence of colorectal cancer or metastases in liver and/or lungs, the sensitivity (SE) in detecting tumor sites was estimated in a single-blind study using conventional planar whole body scintigraphy. Nine patients received F(ab')2 and five received MAB by intravenous infusion over 30 min with a dose of 40-200 MBq after skin testing and thyroid blocking, scanning was performed 1-7 days later. All but one patient had elevated plasma CEA levels with a mean of 25.5 +/- 31.9 ng/ml. The scans were interpreted by two independent observers. In five of the nine patients receiving F(ab')2, the tumor site could be visualized, yielding a sensitivity of 55%. No tumor sites were identified with MAB. The highest tumor uptake was recorded in a patient with additional ovarian cancer with the activity accumulating in the ovarian cancer. The optimum time for imaging was 3 or 4 days after injection. There was no correlation between positive imaging and plasma CEA levels which ranged from 1.9 ng/ml to 100 ng/ml in the positive cases. The thyroid uptake on the sixth day was 0.68% +/- 0.2% of the total dose given despite thyroid blocking. Bone uptake of 131I was also observed, this was mild in four patients, moderate in three but high in one patient, especially on days one to four. Thus, only anti-CEA F(ab')2 seem to be of clinical interest for further evaluation in localizing colorectal cancer. Regarding the still low sensitivity of 55%, further improvement can be expected by gaining experience, using more appropriate isotopes such as 111In and SPECT. The estimated radiation side effects on thyroid and bone marrow are only modest.