膀胱横纹肌肉瘤的病理组织学研究

本文对我院6例原诊断为膀胱葡萄簇状肉瘤的病例进行了临床随访并做了病理组织学研究。全部患者在术后2～12个月内死亡。6例瘤组织的病理学图象基本相同,但有些区域则呈恶性淋巴瘤样或粘液肉瘤样或平滑肌肉瘤样形态。它们虽貌似有多种组织成分,但经特柒证明却只含有胚胎性横纹肌肉瘤成分,而无其它良恶性问叶性瘤组织成分。因此,在病理学命名上,应将它诊断为膀胱横纹肌肉瘤,建议不再使用“葡萄簇状肉瘤”的名称。此外,作者并收集国内文献中报告过的膀胱横纹肌肉瘤(葡萄簇状肉瘤)共69例,结合本文报告6例,详细讨论了它的发病率、命名和组织发生学等临床和病理方面的问题。-     

Left ventricle haemodynamics and vaso-active hormones during graded supine exercise in healthy male subjects

Left ventricle systolic and diastolic functional parameters were measured by gated equilibrium radionuclide cardiography in 12 healthy men (age 33–51 years) at rest and during graded supine exercise. The leftventricle end-diastolic volume showed an initial small (11%) increase during low submaximal exercise [from mean 163 (SD 40) at rest to mean 181 (SD 48) ml], while left ventricle end-systolic volume decreased successively [from mean 59 (SD 19) to mean 39 (SD 21) ml] with increasing exercise. Stroke volume was therefore elevated at all exercise levels compared with rest [mean 104 (SD 23) ml], and the peak value [mean 128 (SD 33) ml] was found at the lowest exercise level, contributing 40% to the initial increase in cardiac output. Cardiac output increased from mean 6.2 (SD 1.4) at rest to mean 20.2 (SD 5.0) 1 · min^–1 at maximum. Left ventricle peak ejection and peak filling rates increased from mean 449 (SD 89) and mean 442 (SD 85) ml · s^–1 at rest to mean 996 (SD 227) and mean 1255 (SD 333) ml · s^–1, respectively, at maximum. The myocardium oxygen consumption, assumed to be proportional to the sum of the stroke work and the potential energy, increased fourfold, but absolute values were twice as high as expected, indicating that extrapolation from data obtained in dog hearts (as we have done) cannot be directly applied to humans. Selected vaso-active hormones were measured at all exercise intensities. Noradrenaline (NA), adrenaline (A) and angiotensin II (AII) concentrations showed a very pronounced increase at maximal exercise compared with the preceding lower intensites, while atrial natriuretic factor (ANF) and cyclic guanosinemonophosphate (cGMP) concentrations showed a more continuous increase, and dopamine (DA) remained almost unchanged. This speaks in favour of a crucial role for NA, A and AII in preserving blood pressure at maximum exercise, while DA probably has no importance for the cardiovascular homeostasis during exercise. Increases in concentrations of ANF and cGMP were highly correlated (r = 0.86). Our data supported the opinion that there is a cardiac limitation to maximal performance connected to the cardiac pumping capacity.     

排尿期尿道压力分布描记诊断膀胱出口梗阻及比较

应用排尿期尿道压力分布描记（ＭＵＰＰ）方法诊断膀胱出口梗阻（ＢＯＯ），并与压力流率结果相比较，对２４例前列腺增生症患者进行排尿期尿道压力测定与压力流率测定，将ＭＵＰＰ所得后尿道压力跌落（ＵＰＧ）与压力流率测定所得尿道阻力因子（ＵＲＡ）及被动尿道阻力关系（ＰＵＲＲ）进行相关性研究与诊断试验。结果表明：ＵＰＧ与ＵＲＡ及ＰＵＲＲ呈显著性正相关，ＭＵＰＰ诊断ＢＯＯ结果与ＡＧ图、ＵＲＡ及ＰＵＲＲ具有较高的诊断符合率。与压力流率相比，ＭＵＰＰ诊断ＢＯＯ各有优点与缺点，但不失为定量诊断ＢＯＯ的一种新方法。     

NOS在膀胱逼尿肌组织中的表达及意义

为探讨一氧化氮（ＮＯ）在人体膀胱的生理和病理改变中的作用，应用免疫组化法和Ｗｅｓｔｅｒｎ印迹法对人体正常膀胱（１０例），前列腺增生症者稳定膀胱（９例）和不稳定膀胱（１２例）逼尿肌组织中的一氧化氮合酶（ＮＯＳ）进行检测。结果显示：膀胱逼尿肌组织中有ＮＯＳ表达，神经节、神经元、神经束和神经纤维皆呈阳性反应，但各类膀胱间的表达量无显著性差异（Ｐ＞０．０５）。提示ＮＯ介导的神经参与调节膀胱逼尿肌的松弛，但在不稳定膀胱的发病机制中不起主要作用     

表浅性膀胱肿瘤的预后

从１９８０年１月至１９９１年１２月，对１２１例表浅性膀胱肿瘤进行回顾性研究，首次手术采用经尿道肿瘤电灼术，电切术或膀胱部分切除术，术后配合膀胱内灌药辅助治疗。其中６０例术后复发（４９．６％），术后１、２、３和５年的无瘤率分别为８６．８％、７６．８％、７３．５％和６８．６％。资料表明，初诊时呈多发者、直径大于１ｃｍ和细胞恶性分级高的肿瘤术后无瘤率分别低于单发者、直径小于１ｃｍ和细胞恶性分级低的肿瘤，有显著性差异（Ｐ＜０．０５）。术后６个月内肿瘤复发者经治疗后肿瘤再次复发的机会高。术后膀胱内灌药可以预防肿瘤复发，以灌注丝裂霉素和卡介苗效果好。     

The radionuclide assessment of left ventricular diastolic filling: methodology and clinical significance

The radionuclide measurement of diastolic performance may provide a rapid noninvasive index available in the clinical setting. These measurements may be used to detect coronary artery disease, manifestations of hypertensive heart disease, isolated diastolic heart failure, and hypertrophic cardiomyopathy. The various radionuclide methods to measure diastolic filling are influenced by technological considerations, as well as applying the results in the appropriate clinical context. The importance of these derived measurements and how they correspond to various pathophysiological presentations will be discussed.     

Lymphoepithelioma-like carcinoma of the bladder: three cases with clinicopathological and p53 protein expression study

Lymphoepithelioma-like carcinoma of the bladder is an uncommon neoplasm, of which 49 cases have been described in the English literature, none of which has been studied for p53 protein expression. We studied three muscle-infiltrating cases of this tumor using immunohistochemical, in situ hybridization and polymerase chain reaction (PCR) methods. The three cases were positive for epithelial markers and negative for lymphoid antigens in the tumoral syncytial areas. The intensive infiltrate of small cells was negative for epithelial and positive for lymphoid markers. This population was mainly made up of cytotoxic T-lymphocytes, positive for TIA-1. p53 protein was intensely positive in more than 90% of the epithelial component nuclei, being negative in the lymphoid cells. PCR study did not show mutations on p53. Both lymphocytes and epithelium were negative for Epstein–Barr virus markers, such as the latent membrane protein and EBER (Epstein–Barr-encoded RNA). The prognosis was very good after radiotherapy and chemotherapy treatment, preserving the bladder despite the muscle infiltration. The presence of an intense cytotoxic T-lymphocyte population may be related to this good prognosis. Both aspects, p53 protein status and T-lymphoid population, had never been studied before in bladder lymphoepithelioma-like carcinoma.     

多发性浅表膀胱移行细胞癌中VEGF的表达及意义

目的:探讨单发性和多发性浅表膀胱移行细胞癌组织中血管内皮生长因子(VEGF)的表达及意义。方法:采用免疫组化方法对60例浅表膀胱移行细胞癌组织及10例正常膀胱组织进行血管内皮生长因子(VEGF)的检测,观察单发性和多发性浅表膀胱移行细胞癌组织中VEGF表达的关系。结果:多发性浅表膀胱移行细胞癌VEGF的高表达明显高于单发者的高表达;VEGF高表达的浅表膀胱移行细胞癌的患者的复发率明显高于低表达者的复发率。结论:VEGF表达的高低与浅表膀胱移行细胞癌的生物学行为有关。     

β-Glucuronidase activation of latent aggression-promoting cues in mouse bladder urine

The present study was designed to investigate the chemical properties of the aggression-promoting cues present in bladder urine of male mice. The results of the first experiment confirmed earlier work by demonstrating the presence of an aggression-promoting chemosignal in bladder urine. In Experiment 2, behavioral assays were separately performed on the organic and aqueous layers of bladder urine obtained by repeated dichloromethane extractions. Only the combined organic layers of the initial three extractions demonstrated behavioral activity. A fourth extraction showed no behavioral activity for both organic and aqueous layers. However, the findings of Experiment 3 showed that incubation of the aqueous layer from the third CH₂Cl₂ extraction in β-glucuronidase can free additional aggression-promoting cues into a subsequent CH₂Cl₂ extraction. It is concluded that two forms of the aggression-promoting chemosignal are present in bladder urine. One is lipophilic and behaviorally active, whereas the other is conjugated, possessing latent chemosignal properties.