喉大部切除联合双蒂肌皮瓣声门整复术的疗效

目的 探讨喉癌手术的疗效,提高喉癌病人的生存质量。方法 ５３例男性声门型鳞状细胞癌采用垂直前侧位喉大部切除颈前皮瓣和肌筋膜双蒂整复术。术后辅以放疗。结果 ５３例病人术后吞咽及发音功能基本恢复,拔管率９２．５％,３年生存率为８２．５％,５年生存率为７６．８％。结论 对一侧声带癌向前至声带前联合并累及对侧声带前１／３的病人,采用垂直前侧位喉大部切除颈前皮瓣和肌筋膜双蒂整复是一种有效的术式,在切除肿瘤的     

大肠癌组织中HPV16、18E6,ras癌基因蛋白表达的研究

为探讨人乳头瘤病毒 16、18型感染与 p2 1ras癌基因协同在大肠癌发生机理中的作用 ,采用SP免疫组化技术 ,检测30例大肠腺瘤、10例腺瘤恶变、5 3例大肠腺癌和 30例正常大肠粘膜组织中HPV16、18E6 ,p2 1ras蛋白并分析其相互关系。结果显示 :腺瘤、腺瘤恶变和腺癌组中E6 ,p2 1ras的阳性表达分别为 36 .7% (11/ 30 )、40 .0 % (12 / 30 ) ,6 0 .0 % (6 / 10 )、70 .0 % (7/ 10 )和 5 4.7% (2 9/ 5 3)、71.7% (38/ 5 3) ,而正常组均呈阴性表达。在腺瘤组中 ,随着上皮不典型性增生程度的加重 ,E6、p2 1ras的阳性表达呈逐渐上升的趋势。腺瘤伴不典型性增生Ⅱ～Ⅲ级组中E6、p2 1ras阳性表达显著高于腺瘤伴不典型性增生Ⅰ级 (P <0 .0 5 )。此外 ,腺瘤、腺瘤恶变及腺癌组中E6与 p2 1ras的双阳性表达差异均有显著性 (P <0 .0 5 )。在有淋巴结转移组中 ,E6的阳性表达和E6与p2 1ras的双阳性表达均显著高于无淋巴结转移组 (P <0 .0 5 )。提示高危HPV16、18感染并在活化的ras癌基因的协同参与下 ,与本地区大肠癌的发生、发展过程密切相关 ,在腺瘤中同时检测E6、p2 1ras蛋白有可能成为大肠癌早期诊断的免疫学指标之一。     

University Students'' Knowledge and Awareness of HPV

BACKGROUND: The purpose of this study was to evaluate the knowledge, attitudes, and behaviors of university students regarding the human papillomavirus (HPV). METHODS: A random sample of 500 university students was mailed a self-administered questionnaire that elicited their knowledge and awareness about HPV and compared their knowledge and attitudes with those of other sexually transmitted diseases (STDs). Among the 480 deliverable addresses, 289 students responded (response rate 60%). RESULTS: Only 37% of respondents had ever heard of HPV, and the median score on a 13-item knowledge scale was only 3. Of seven STDs assessed, respondents indicated they knew the least about HPV and perceived that this STD has received the least educational effort. In multivariate analyses, predictors of lower knowledge and awareness about HPV were male gender and sexual behavior (having multiple partners, not using condoms). CONCLUSIONS: Despite the high prevalence of HPV among young adults, most students knew very little about this infection. Implementing HPV educational programs and measuring their effectiveness should be a priority.     

喉癌p53基因突变与人乳头状瘤病毒感染的关系

目的探讨喉癌细胞ｐ５３基因突变与人乳头状瘤病毒（ＨＰＶ）感染的关系及其临床意义。方法应用星普旋转离心柱Ｂ溶液系统,结合聚合酶反应链多态性分析（ＰＣＲ－ＳＳＣＰ）及ＤＮＡ序列分析（ＰＣＲ－ＤＮＡＳｅｑｕｅｎｃｉｎｇ）,对３６例喉癌组织新鲜标本进行ＨＰＶ定型、相对定量及ｐ５３基因第４至第８外显子突变检测。结果３６例喉癌标本中有１３例发生基因点突变或转码突变,其中１０例为ＨＰＶ１６／１８感染者,且与细胞内病毒含量呈正相关。２４例晚期喉癌（临床Ⅲ－Ⅳ期）有颈淋巴结转移者突变检出率明显高于无转移者（Ｐ＜０．０５）。结论喉癌ｐ５３基因突变与ＨＰＶ１６／１８感染有关,晚期喉癌颈淋巴结转移与ｐ５３基因突变有关。     

喉癌中抗凋亡基因bcl—2蛋白的表达及其临床意义

目的　探讨细胞凋亡抑制基因ｂｃｌ－ ２ 蛋白产物在喉癌中的表达及其临床意义。方法　应用免疫组化ＳＡＢＣ方法检测４１ 例喉癌切除标本石蜡切片组织。结果　ｂｃｌ－ ２ 蛋白在喉癌组织中有过度表达,其阳性表达率为５１２ ％ （２４／４１） ;ｂｃｌ－ ２ 表达与喉癌病理组织学分级相关,肿瘤分化程度越高,ｂｃｌ－ ２ 阳性表过率越高（ Ｐ＜ ００５） ,早期（ Ⅰ、Ⅱ期） 喉癌中ｂｃｌ－ ２ 表达明显高于晚期（ Ⅲ、Ⅳ期）（ Ｐ＜００５） ;ｂｃｌ－ ２ 表达与肿瘤复发、转移无关Ｐ＞ ００５） ;而与预后明显相关,ｂｃｌ－ ２ 阳性组三年生存率明显高于阴性组Ｐ＜ ００５） 。结论　ｂｃｌ－ ２ 基因在喉癌中有异常表达,与喉癌的发生、发展相关,并可作为判断其预后的指标之一     

喉部癌肉瘤的病理及免疫组化诊断

目的　探讨喉部癌肉瘤的诊断和鉴别诊断。方法　选取喉部鳞癌10例,梭形细胞癌3例,癌肉瘤2例,恶性淋巴瘤6例,恶性纤维组织细胞瘤4例,横纹肌肉瘤4例,共29例,全部进行病理光镜复查及免疫组化检测。结果　癌肉瘤呈多次病理活检,报告前后不一,全喉标本肿瘤表面光滑,基底部小,切面组织细嫩,光镜显示肿瘤同时具有恶性的上皮成分和恶性的间叶成分。从形态上看癌肉瘤与梭形细胞癌最易混淆,免疫组化检测,恶性的上皮成分CK( ),VIM(-),而恶性的间叶成分则CK(-),VIM( ),梭形细胞癌肿瘤区域CK( ),VIM(-)。结论　喉部癌肉瘤的诊断应慎重,需有典型的病理形态及可靠的免疫组化检测手段和严格的评判标准     

Postoperative sore throat: cause, prevention and treatment

Sore throat is a common postoperative complaint, occurring most often following tracheal intubation. Factors such as tracheal-tube size and cuff design have been shown to be important causative factors. Routine tracheal intubation for elective surgical procedures can result in pathological changes, trauma and nerve damage which may also account for postoperative throat symptoms. Sore throat following the use of a laryngeal mask appears to be related to the technique of insertion but the contribution of intracuff pressure remains to be clarified. It would appear, however, that high intracuff pressure is associated with nerve palsies due to neuropraxia and nerve compression. Careful insertion techniques for both the tracheal tube and laryngeal mask are of paramount importance in the prevention of airway trauma and postoperative sore throat.     

Anale spitze Kondylome beim HIV-positiven Patienten

Zusammenfassung Seit Juli 1986 erfassen wir alle Patienten mit analen spitzen Kondylomen, prüfen den HIV-Status, sofern nicht bereits bekannt, and identifizieren das zugrunde liegende Human papilloma virus (HPV) mittels DNA-DNA-Hybridisierung (Southern-Blot). Von 70 erfaßten Patienten sind 39 seropositiv. Das Verhdltnis von Männern and Frauen beträgt 59 zu 11, bei seropositiven Patienten 35 zu 4 and bei seronegativen 24 zu 7. Das Durchschnittsalter liegt bei 28 respektive 31 Jahren. Der Anteil an Fixern and Homosexuellen liegt bei den Seropositiven signifikant höher. Nach der CDC-Klassifikation sind 17 Patienten im HIV-Stadium II, 11 im Stadium III and 10 im Stadium IV. Charakteristisch für die sero-positive Gruppe sind ausgedehnte Kondylomrasen auf der Rektalschleimhaut sowie rasant wachsende Restbefunde bei anfdnglich subtotaler Resektion zur Steno-seprophylaxe. Bei 65 Patienten wurde eine primdr radikale Resektion mit dem Elektrokauter vorgenommen. Ober-raschenderweise liegt die Rezidivquote bei Seronegativen höher, wobei das Rezidiv klein ist. Eine Hypothese dazu wird präsentiert. Postoperative Komplikationen traten nur in den HIV-Stadien III and IV auf. Wir empfehlen deshalb in diesen Stadien eine perioperative Antibiotika-prophylaxe. Die HPV-Identifikation ergab keine mit Malignität assoziierten Typen. Wir finden eine Häufung von HPV 11 bei seropositiven Patienten, deren Bedeutung uns nicht klar ist. Wir schlieen aus unseren Ergebnissen, daß, bei gegebener Operationsindikation, die primär radikale Abtragung der Kondylome mit dem Elektrokauter beim HIV-positiven Patienten notwendig ist and beim seronegativen ein sicheres Verfahren darstellt. In den HIV-Stadien III and IV ist eine Antibiotikaprophylaxe notwendig. Anale spitze Kondylome sind ein Hinweis auf eine mogliche HIV-Positivitdt.

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Anal codylomata acuminata in HIV-positive patients

Summary Since July 1986 we started with following all patients with condylomata acuminata including HIV-testing and human papilloma virus (HPV) identification by DNA-DNA-hybridisation (southern blot). Seventy patients are included, 39 of them are seropositive. The ratio male to female is 59 to 11, in seropositives 35 to 4, in negatives 24 to 7. The average age is 28 and 31 years respectively. The number of homosexuals and junkies is significantly higher in seropositives. Seventeen patients are in HIV-stage II, 11 in stage III and 10 in stage IV according to CDC-classification. Characteristic for the seropositives was an extensive growth on the rectal mucosa and the very rapid growth of initially subtotally resected lesions in order to prevent stenosis. Sixty-five patients were treated by one stage radical operation with electrocauter. Surprisingly recurrency is more frequent in seronegatives, however, the lesion is much smaller in this group. A hypothesis to explain this observation is brought forward. Postoperative complications occurred only in HIV-stages III and IV We therefore recommend single shot antibiotic prophylaxis in these patients. The HPV-identification showed no malignancy associated HPV-types in both groups but a higher incidence of HPV 11 in higher HIV-stages which we cannot explain. We conclude from our series that, if operation is indicated, one stage radical electrocoagulation of condylomata acuminata is a necessary procedure in seropositive patients and a save one in negative patients but antibiotic prophylaxis should be given in stage III and IV. Anal condylomata acuminata are a hint for possible HIV-positivity.

     

喉罩在腹腔镜胆囊切除手术中的临床应用

目的探讨喉罩在腹腔镜下胆囊切除手术对呼吸循环的影响。方法:所有病人均面罩吸氧去氮5分钟后,以Fentaly0.2mg.Norcriun 0.1mg/kg Propofol 2mg/kg静注给药诱导放置I型3号喉罩,术中观察BP、HR、EtCO2、Ppeak、SaO2。结果喉罩通气组循环稳定,BP、HR变化明显较气管插管组小。EtCO2、Ppeak、SaO2,两组无明显变化。结论使用喉罩通气进行腹腔镜下胆囊切除手术是一种安全、可靠和易行的方法。     

电视监视纤维喉镜下Nd:YAG激光治疗声带良性病变

目的 :报告 68例声带良性病变患者 ,在电视监视纤维喉镜下运用 Nd:YAG激光治疗的临床疗效。方法 :回顾分析 68例声带良性病变患者临床资料。结果 :68例中 ,治愈 64例 ( 94.1% ) ,好转 4例 ( 5 .9% ) ,无 1例复发。结论 :电视监视纤维喉镜下 Nd:YAG激光治疗声带良性病变具有快捷、死角小、精确度高、并发症少、图像清晰、患者痛苦小和不易复发等优点 ,值得临床推广应用