Barrett’s esophagus: Review of natural history and comparative efficacy of endoscopic and surgical therapies

Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC). Progression to cancer typically occurs in a stepwise fashion through worsening dysplasia and ultimately, invasive neoplasia. Established EAC with deep involvement of the esophageal wall and/or metastatic disease is invariably associated with poor long-term survival rates. This guides the rationale of surveillance of Barrett’s in an attempt to treat lesions at an earlier, and potentially curative stage. The last two decades have seen a paradigm shift in management of Barrett’s with rapid expansion in the role of endoscopic eradication therapy (EET) for management of dysplastic and early neoplastic BE, and there have been substantial changes to international consensus guidelines for management of early BE based on evolving evidence. This review aims to assist the physician in the therapeutic decision-making process with patients by comprehensive review and summary of literature surrounding natural history of Barrett’s by histological stage, and the effectiveness of interventions in attenuating the risk posed by its natural history. Key findings were as follows. Non-dysplastic Barrett’s is associated with extremely low risk of progression, and interventions cannot be justified. The annual risk of cancer progression in low grade dysplasia is between 1%-3%; EET can be offered though evidence for its benefit remains confined to highly select settings. High-grade dysplasia progresses to cancer in 5%-10% per year; EET is similarly effective to and less morbid than surgery and should be routinely performed for this indication. Risk of nodal metastases in intramucosal cancer is 2%-4%, which is comparable to operative mortality rate, so EET is usually preferred. Submucosal cancer is associated with nodal metastases in 14%-41% hence surgery remains standard of care, except for select situations.     

坐骨重叠征与发育性髋关节脱位手术后再脱位的相关性分析

目的提出坐骨重叠征(ischium overlap sign,IOS)的概念,并分析其与发育性髋关节脱位(developmental dysplasia of the hip,DDH)手术后再脱位的关系。方法回顾性分析2013年9月至2017年5月山东大学附属省立医院治疗的88例(105髋)DDH患儿病例资料,其中男童16例、女童72例;平均年龄12(5~24)个月,平均随访时间34(15~59)个月;双侧17例,左侧63髋,右侧42髋;1髋为髋臼发育不良,11髋半脱位,93髋全脱位。术中行髋关节造影检查,按照Bowen标准选择闭合或切开复位石膏固定术。IOS是指在人类位髋关节造影平片上股骨头软骨内缘与坐骨外缘的重叠关系,二者重叠为Ⅰ度,相接为Ⅱ度,分离为Ⅲ度。将93髋全脱位按照IOS分度进行分组,比较组间再脱位发生率。结果 1髋髋臼发育不良和11髋半脱位者IOS均为Ⅰ度。93髋全脱位中IOSⅠ度14髋,Ⅱ度39髋,此两组均行闭合复位石膏固定,无再脱位病例;Ⅲ度40髋中,闭合复位石膏固定17髋,6髋再脱位;切开复位石膏固定23髋,1髋再脱位。本研究发现Ⅲ度组的再脱位发生率(7/40,17.5%)高于其他两组(P=0.006)。IOS为Ⅲ度的40髋中,闭合复位的再脱位发生率(6/17,35.3%)高于切开复位(1/23,4.4%),差异有统计学意义(X^2=4.518,P=0.034)。结论 IOS与DDH术后再脱位有一定的关系,IOS为Ⅲ度的髋关节如行闭合复位,再脱位的风险较高。     

不同方法髋臼重建的全髋关节置换术治疗先天性髋关节发育不良

目的探讨不同方法髋臼重建的全髋关节置换术治疗先天性髋关节发育不良的临床效果。方法1995年8月~2004年10月笔者对126例(141髋)先天性髋关节发育不良继发骨关节炎的患者施行全髋关节置换术,对57例(66髋)进行了1·1~9年随访,平均随访6·5年。结果至末次随访时CroweⅠ~Ⅱ级患者Harris评分平均改善57·4分,CroweⅢ级患者平均改善47·1分,CroweⅣ级患者平均改善46·5分。脱位4例,2例手法复位,1例手术翻修纠正过大的髋臼前倾角,另1例去除小生物型髋臼假体,采用髋臼加强环翻修。另有3例因松动、2例因感染而行翻修术,共6例患者进行翻修。股神经牵拉伤3例,坐骨神经牵拉伤1例,术后1~3个月恢复,2例深静脉血栓,异位骨化发生率9·1%(6髋),但对功能无明显影响。结论对于先天性髋关节发育不良患者行全髋关节置换术时,根据髋臼缺损的类型采用不同方法进行髋臼重建,可以收到良好的临床效果,但随着Crowe分级的增加,手术难度加大,术后Harris评分降低。     

460例胃癌纤维胃镜活检标本的病理观察

本文分析了460例胃癌胃粘膜活检资料,结果:男:女为2.36:1:51～60岁年龄组发病率最岛(37.17％);发生部位以胃窦部最多见,占46.74％;组织学分类以低分化腺癌最多,占51 52％;在伴随病变中,畅化生的检出率为21.74％,胃腺囊为35％,胃粘膜上皮异型增生为32.61％。本组材料提示,不完全性大肠型肠化生、异型胃腺囊及胃粘膜中度以上异型增生与胃癌有密切关系。     

Short-term estrogen test for cytodiagnosis in postmenopausal women

A short-term estrogen test was used to obtain a correct cytologic diagnosis in 73 patients with an equivocal atrophic cellular pattern. Overestimation in cytodiagnosis was markedly eliminated, and the correct cytologic diagnosis was made in 81% of the cell samples after the estrogen test. The purpose of this study was not only to confirm the usefulness of the short-term estrogen test, but also to observe the cytomorphologic changes before and after the test. Thick cytoplasm, vacuoles in the cytoplasm, and a distinct cell border increased, while the amorphous chromatin pattern was eliminated after the estrogen test. Maturation of atypical cells in cases of dysplasia, carcinoma in situ, and invasive squamous-cell carcinoma was investigated before and after the estrogen test. Although malignant cells were not influenced by estrogen, maturation of dysplastic cells was induced after the test.     

Dysplasia in the gastrointestinal tract: definition and clinical significance

Summary The term dysplasia is used increasingly in gastrointestinal pathology. Dysplasia denotes an unequivocal neoplastic epithelial alteration without invasive growth and is synonymous with the term intraepithelial neoplasia. Dysplasia is the paradigm of a precancerous lesion. Confusion arises because some pathologists do not use the term in the above-defined sense but to describe regenerative, inflammatory and reactive changes. It is essential to separate these kinds of non-neoplastic epithelial changes from neoplastic dyplasia because the clinical consequences are completely different. The general morphology and the grading of dysplasia are described. Most dysplasias in the gastrointestinal tract are the polypoid lesion; dysplasias in flat mucosa are uncommon. Knowledge of the incidence of dysplasia in the gastrointestinal tract is important for the concept of secondary cancer prevention.     

桥本氏甲状腺炎并发甲状腺癌的临床病理学研究

目的 探讨桥本氏甲状腺炎并发甲状腺癌的临床病理学特征和癌发生的病理学基础。方法 采用HE染色和免疫组化法观察16例桥本氏甲状腺合并甲状腺癌和12例单纯甲状腺癌的病理学形态和基因蛋白的表达。结果 桥本氏甲状腺合并甲状腺主要为乳头状癌。镜下可见淋巴组织增生病变区甲状腺滤泡上皮细胞不典型增生,中度表达p53、Ki67、bcl-2和c-erbB-2,与癌组织的表达无显著差异（P＞0．05）,而极显著高于非甲状腺炎的癌旁组织（P＜0．01）。结论 桥本氏甲状腺炎合并甲状腺可能是在多基因协同作用下,残存的滤泡上皮细胞发生不典型增生而癌变。     

p53基因突变与肺癌发生的早期遗传学损害

在进行肺癌与ｐ５３基因关系的系列研究过程中，发现１例支气管粘膜上皮不典型增生和１例原位癌，运用免疫组织化学方法进行ｐ５３蛋白表达检测，结果发现支气管上皮不典型增生和原位癌组织中有明显的ｐ５３蛋白阳性染色细胞，从而进一步证实了ｐ５３基因突变可能是肺癌发生的早期遗传学损害。     

Morphology of Tricuspid Valve in Pulmonary Atresia with Intact Ventricular Septum

Pulmonary atresia with intact ventricular septum (PAIVS) is a rare congenital cardiac anomaly that has been classified into two types: one is a more frequent type having dysplasia of tricuspid valve (TV) with a small annulus, underdeveloped right ventricle (RV) with a hypoplastic cavity and a hypertrophic wall; the other type has severe dysplasia of TV and dilatation of RV, right atrium (RA), and right atrioventricular junction with thinning of the RV wall. We performed a morphologic study on 11 autopsied hearts with PAIVS, giving particular emphasis to the variation of morphology of the TV. We could classify these hearts into 3 groups according to the degree of right ventricular development. In the first group of 7 cases (type I), the RVs were underdeveloped. Thick leaflets, restricted valve apparatus with short chordae, and small annuli were characteristics of the TV. In the second group of 3 cases (type II), the RVs showed marked enlargement of the cavity and thinning of the wall. The TV showed redundant, dysplastic, sail-like anterior leaflets, and the downward displacement of septal leaflet and/or posterior leaflet, which are the findings frequently observed in Ebstein's malformation. The RVs were dilated and with partially unguarded tricuspid orifice. The septal leaflet of the TV was dysplastic and, in two cases, the septal leaflet showed chordal structure at the upper surface facing the RA, which is a peculiar finding that has not been described in the literature. The remaining case was a heart with a moderately developed RV (type III). The TV showed mildly dysplastic appearance and we classify this as a separate type, because we could expect the best surgical results in this type. This type had optimal size of RV and the mildest degree of dysplasia of TV. In PAIVS, the morphology of TV correlates well with the type of the right ventricular development.     

性分化与性发育异常13例分析

目的:探讨性分化和发育异常的临床特点,并对腹腔镜在治疗中的应用进行评价。方法:对我院13例行腹腔镜切除性腺的性分化和发育异常病例资料进行分析。结果:13例均为女性外阴,含有Y染色体或Y的成分,性腺位于腹腔内或腹股沟内,4例为条索状原始性腺,9例为睾丸。3例有始基子宫和输卵管。性激素水平符合绝经期表现。11例经腹腔镜完成手术,2例转传统手术,手术后1~2天出院。结论:含有Y染色体或Y成分的性腺位于腹腔或腹股沟内并且丧失正常功能,是手术切除的指征,腹腔镜手术具有微创和术后恢复快的优势。