Posterior urethral valves in patients with Down syndrome

Renal and urological anomalies in Down syndrome (DS) have received little attention compared with the nephrourological findings described in other chromosomal abnormalities. Renal hypoplasia, hydroureteronephrosis, ureterovesical and ureteropelvic junction obstruction, and vesicoureteral reflux, but not posterior urethral valves, have been associated with DS. We report the occurrence of posterior urethral valves in three male infants with DS at a single institution. All had multiple urological procedures for correction or palliation of obstruction. Children with DS may have an increased risk for developing posterior urethral valves and obstructive uropathy. Furthermore, they may also develop chronic renal failure secondary to posterior urethral valves. Therefore, we suggests that infants with DS be screened with ultrasonography for renal and urological abnormalities early in life and, if abnormal, a contrast voiding cystourethrogram be performed to rule out posterior urethral valves or other bladder or urethral abnormalities. A review of the renal and urological anomalies in DS reported in the literature since 1960 is presented.     

Molecular oncogene markers and their significance in cutaneous malignant melanoma

Background: Oncogenes and other molecular tumor markers that predict tumor aggressiveness may allow individualization and optimization of surgical therapy of intermediate-thickness malignant melanoma. We examined the expression of selected markers, including the HLA-DR antigen, the heat shock protein-70 (HSP-70), and the c-myc oncogene in primary melanoma and regional nodes and related these findings to metastatic potential and survival. Methods: Forty patients with primary melanoma (1.5–4.0 mm) were studied, all of whom had prophylactic lymph node dissection and were followed for 18 months to 7 years. The primary tissue and nodes were examined using immunohistochemical techniques for the presence of HLA-DR antigen and HSP-70 protein and the expression of the c-myc oncogene. Results: Of 40 patients, there were 23 with lesions 1 to 2.9 mm thick and 17 with lesions 3 to 4 mm thick. Nodal metastases were present in 25 of the 40 patients who had elective node dissection. HLA-DR antibody stained the primary tumor in 10 patients (25%), but there was no correlation with survival in this group. HLA-DR antibody stained the stroma and cellular infiltrates surrounding the primary tumor in 28 of 40 patients; in this group there was a correlation of HLA-DR staining of the peritumoral stroma with improved survival overall. HLA-DR staining of the peritumoral stroma also influenced survival when patients were stratified by tumor thickness groups 1 to 2.9 mm and 3 to 4 mm and presence of nodal metastases. HSP-70 was demonstrated in the primary tumor in 25% of patients, who were also shown to have significantly improved survival when compared with those whose primary tumor did not stain with HSP-70. C-myc was expressed in the primary tumor in 25%, but showed no correlation with survival. None of these proteins correlated with or predicted the presence of nodal metastases. Conclusion: We conclude that the use of specific molecular-oncogene markers in intermediate-thickness primary melanoma may identify patients at high risk for conventional treatment failure and reduced survival who may profit from more aggressive surgery, adjuvant therapy, or both.Presented at the 48th Annual Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

药物敏感试验指导肺癌合并恶性胸腔积液的顺铂联合其他药物胸腔内化疗

目的用药物敏感试验预测肺癌合并恶性胸腔积液癌细胞对顺铂联合其他药物的敏感度，观察其在指导此类患者的顺铂联合其他化疗药物胸腔内化疗的价值。方法将44例胸腔积液癌细胞阳性肺癌患者随机分为两组：药物敏感试验组（20例，有2例因体外药物敏感试验失败而被排除）和对照组（22例）。药物敏感试验组患者用三磷酸腺苷-肿瘤细胞药物敏感试验（ATP-TCA）法分别检测胸腔积液癌细胞对顺铂加香菇多糖、顺铂加甘露聚糖肽、顺铂加A群链球菌制剂、顺铂加干扰素、顺铂加金黄色葡萄球菌滤液制剂、顺铂加卡介苗多糖核酸、顺铂加红色诺卡菌细胞壁骨架、顺铂加白细胞介素-2的敏感度，并选择抑瘤率最高的联合化疗药物对患者进行胸腔内化疗，观察治疗后胸腔积液完全缓解率及胸腔积液癌细胞转阴率，并与对照组比较。结果药物敏感试验组患者对各联合化疗药物敏感的例数为：顺铂加香菇多糖14例、顺铂加甘露聚糖肽18例、顺铂加A群链球菌制剂17例、顺铂加干扰素10例、顺铂加金黄色葡萄球菌滤液制剂16例、顺铂加卡介苗多糖核酸15例、顺铂加红色诺卡菌细胞壁骨架17例、顺铂加白细胞介素-216例。药物敏感试验组完全缓解率为65．0％，对照组为27．3％（P〈0．05）。药物敏感试验组胸腔积液癌细胞转阴率为80．0％，对照组为45．5％（P〈0．05）。结论用药物敏感试验指导肺癌合并恶性胸腔积液的胸腔内个体化化疗可提高完全缓解率和胸腔积液癌细胞转阴率，该方法具有临床实用价值。     

奥沙利铂持续腹腔热灌注治疗癌性腹水的临床研究

目的研究奥沙利铂(L-OHP)持续腹腔热灌注治疗癌性腹水的疗效和毒副作用。方法将76例癌性腹水患者随机分为三组:奥沙利铂持续腹腔热灌注化疗组(热化组)26例,引出腹水后,在加热的5%葡萄糖溶液2500～3500ml中加入L-OHP200mg/m2,持续体外循环腹腔热灌注,腹腔内温度保持在41～43℃,持续60min;腹腔内注射奥沙利铂化疗组(单化组)26例,常规腹腔穿刺引流腹水后注射L-OHP200mg/m2。单纯腹腔热灌注组(单热组)24例,加热5%葡萄糖溶液2500～3500ml,持续热灌注60min。结果总有效率(CR PR)54%(41/76)。热化组、单化组和单热组的有效率分别为76.9%(20/26)、50.0%(13/26)、33.3%(8/24),P<0.05。急性腹痛:热化组53.8%(14/26),单热组16.7%(4/24)。单化组无急性腹痛病例,P<0.05。麻痹性肠梗阻:热化组19.2%(5/26),单化组7.7%(2/26),单热组16.7%(4/24),P>0.05。结论奥沙利铂持续腹腔热灌注治疗恶性腹水是一种新的有效的治疗方法,毒副作用不大。     

Adamantinoma of the proximal femur: a case report

Adamantinoma is a rare low-grade malignant bone tumor with an indolent course. The tibia is involved in 85%–90% of long-bone cases. We encountered a patient with primary adamantinoma of the proximal femur. A 60-year-old woman fell and fractured her proximal left femur in the area of a cystic lesion. She underwent an osteosynthesis procedure, and bone union was obtained. After 3 years she developed pain in the left thigh, and a radiographic abnormality was found at the fracture site. A metastatic bone tumor was suspected, and curettage and cementing were carried out. Histologically, we found an epithelial component but failed to detect any primary cancer. Local recurrence became evident after another 6 years. A marginal excision was performed and a bipolar femoral prosthesis was implanted. We finally diagnosed the patient with adamantinoma. In this report we describe the characteristics of this tumor and discuss the reasoning concerning the differential diagnosis and therapeutic plan.     

选择性输卵管造影与再通术在诊治阻塞性不孕中的价值(附200例报告)

目的 :评价选择性输卵管插管造影 (SSG)及再通术 (FTR)在输卵管阻塞性不孕中的诊治价值。材料和方法 :先经宫颈对常规子宫、输卵管造影 (HSG)显示输卵管阻塞的 2 0 0例不孕妇女的 380条输卵管进行插管 ,采用选择性插管至输卵管开口处推注 76 %泛影葡胺造影 ,对证实阻塞者行导丝再通术 ,术后随访 2～ 4个月。结果 :插管成功率 99% ,无严重并发症 ,复通率 90 % ,妊娠率 2 1% (4 2 / 2 0 0 )。结论 :SSG和FTR是目前诊治输卵管阻塞性不孕的最好方法     

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目的通过对比合并与不合并注意缺陷多动障碍(ADHD)的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)儿童的多导睡眠监测指标,试图从睡眠结构和睡眠主要参数的层次上来探讨ADHD的发病机制。方法选择2004-01—2006-10于广州市儿童医院就诊的OSAHS患儿36例作为OSAHS组,合并有OSAHS的ADHD患儿20例作为观察组,选取无OSAHS及ADHD的儿童30例作为对照组,三组之间在年龄、性别、体重指数等方面相比,差异无显著性。通过多导睡眠监测(PSG),并由神经康复科专科医生对其是否患有ADHD作出诊断。采用相应的统计学方法,对OSAHS组、观察组及对照组的睡眠结构进行比较,并对OSAHS组和观察组进行呼吸事件及血氧状况的比较。结果(1)与对照组相比,OSAHS组及观察组睡眠Ⅰ期增加,睡眠Ⅱ期、SWS及REM睡眠减少,差异有统计学意义(P<0.05),OSAHS组的REM%为8.66±3.94,观察组的REM%为5.65±5.41,REM%的改变有统计学意义(P<0.05)。(2)观察组儿童呼吸事件的次数与持续时间及血氧饱和度下降较OSAHS儿童严重,差异有统计学意义(P<0.05)。结论观察组儿童REM%及血氧饱和度的下降可能在ADHD的发病中起一定的作用。     

阻塞性黄疸大鼠肾脏自分泌内皮素的变化及其与肾功能损害的关系

目的　探讨阻塞性黄疸时肾脏自分泌内皮素 (ET)的变化及其与肾功能损害的关系。方法　结扎胆总管(BDL)制备阻塞性黄疸大鼠模型 ,作为实验组 ,对照组鼠仅行假手术。分别于术后 5、1 0及 1 5d ,两组各取 1 0只大鼠检测其肾脏对氨基马尿酸清除率 (CPAH)、菊粉清除率 (CIN)和钠排泄分数 (FENa+) ,并用鲎试剂法测定血浆内毒素 (EX)水平 ,放射免疫法测定肾动、静脉血浆及肾组织中ET 1含量。结果　①实验组术后 5d仅FENa+明显高于对照组 (P<0 .0 1 ) ,术后 1 0d起 ,CPAH、CIN及FENa+呈进行性下降 ,术后 1 5dFENa+已较对照组低 ,与对照组比较差异有显著性 (P<0 .0 1 ) ;②实验组术后血浆EX水平呈进行性升高 ,与对照组比较差异有显著性 (P<0 .0 1 ) ;③实验组术后肾动脉血浆ET 1水平呈持续性降低 ,而肾静脉血浆及肾组织中ET 1含量呈持续性升高 ,与对照组比较差异有显著性 (P<0 .0 1 ) ;④血浆EX水平与肾组织ET 1含量呈正相关 (r =0 .762 4 ,P<0 .0 1 ) ,肾组织ET 1含量与CPAH和CIN呈负相关 (r=- 0 .883 2 ,P<0 .0 1 ;r =- 0 .945 2 ,P<0 .0 1 )、与FENa+呈正相关 (r=0 .873 4 ,P<0 .0 1 )。结论　内毒素血症及其诱导的肾内ET分泌增加在阻塞性黄疸所致大鼠肾损害中可能具有重要作用     

金属内支架介入治疗恶性输尿管狭窄的临床应用

目的探讨经皮顺行植入输尿管金属内支架治疗恶性输尿管狭窄的效果。方法对14例恶性肿瘤伴输尿管狭窄的患者行经皮顺行植入输尿管金属内支架治疗。术后观察尿量及性状,超声及腹部平片随访。结果14例患者植入输尿管内支架均获成功,输尿管梗阻解除,患者临床症状改善,肾功能好转。结论对恶性输尿管狭窄的患者行顺行植入输尿管金属内支架治疗输尿管狭窄,是一种简便、有效、创伤小的治疗方法。     

Malignant lymphoma. Pathology, diagnosis, therapy

Summary Malignant lymphomas can be subdivided into Hodgkin's disease and low- or high-grade non-Hodgkin's lymphoma (NHL). The principal therapeutic options are polychemotherapy and radiotherapy. Besides the histological classification, staging of the disease with particular regard to risk factors is an essential prerequisite for the therapeutic decision. Diagnostic imaging modalities such as computer tomography, magnetic resonance imaging, and ultrasonography have improved the accuracy of clinical staging such that invasive pathological staging is only necessary in exceptional cases. A novel therapeutic approach is high-dose chemotherapy with autologous haematopoietic stem-cell support. This treatment improves the survival of patients with relapsed high-grade NHL. The place of high-dose therapy as the primary therapeutic option in malignant lymphoma is now being assessed in prospective studies following encouraging results from single-centre studies, including those involving the treatment of low-grade lymphoma. The effects of antibodies directed against lymphatic cells are currently being examined in experimental treatments. An assessment of the viability and rate of proliferation of lymphoma tissue on completion of therapy using sensitive radiological and nuclear medical methods is an important aim for the future. Eingegangen am 5. November 1996 Angenommen am 12. November 1996