用图像分析仪研究人冠状动脉内膜增厚及细胞增殖与动脉粥样硬化病变关系

为探索冠状动脉内膜增厚及细胞增殖与动脉粥样硬化的关系，应用图像分析仪测量２１８例年轻人冠状动脉左前降支的内膜厚度、细胞核数量、细胞核数密度和面密度，结合动脉粥样硬化各类病变特点进行统计学的相关分析。结果表明：随着冠状动脉内膜增厚，男性和女性动脉粥样硬化病变的程度加重，且两者呈显著正相关；随着冠状动脉内膜细胞数量增多及细胞核数密度和面密度的下降，细胞外基质成分的增多，男性和女性动脉粥样硬化病变的程度逐渐加重。提示冠状动脉内膜增厚与动粥样硬化病变的发生发展关系密切，细胞增殖及细胞外基质成分增多在动脉粥样硬化病变的发生发展中起重要作用。     

食管癌高、低发区胃粘膜活检的病理比较分析

本文对食管癌高发区辉县及低发区范县的内镜活检胃粘膜进行了组织学对比分析。结果表明,不论高、低发区慢性胃炎都很常见,高发区总检出率为77.66％,低发区为68.64％,前者明显高于后者(P<0.01),各型胃炎中萎缩性胃炎的检出率高发区明显高于低发区(P<0.01),肠化出现率高发区也比低发区高(P<0.05),由此可见,食管癌高发区慢性胃炎患病情况较低发区更严重。     

食管、胃肿瘤螺旋CT检查探讨

 目的 探讨食管、胃肿瘤的CT检查方法及对术前临床分期的指导意义。方法 60例患者，其中食管癌 25例，贲门癌 15例，胃癌 20例，均经手术病理证实，采用低张充水法行螺旋CT扫描。结果 60例患者CT检查可清楚显示病变区食管壁、胃壁增厚，管腔狭窄，轮廓改变以及病变向管腔外浸润程度及周围器官、淋巴结转移情况。结论 低张充水法螺旋CT扫描，可以清楚显示食管癌、胃癌向管壁内外浸润的程度，对术前肿瘤分期及治疗方案选择有重要指导意义。     

食管癌与肾癌并存1例报告

患者男性 ,62岁 ,2年来感进食不顺 ,尤以硬性食物为著 ,不影响工作 ,未予诊治。近感胸骨后不适 ,无胸背痛 ,无发热及呕吐 ,可进半流食 ,仍坚持工作。体检 :一般情况尚好 ,各项化验及胸部 X线摄片均末见异常 ,食管造影示中下段病变 ,长约 8cm,管腔狭窄 ,不规则充盈缺损 ,黏膜破坏 ,可见龛影 ,通过受阻。B超示 :右肾上极探及 5 cm大小低回声肿物 ,局限于被膜内 ,向肝肾间隙生长 ,左肾未见病变 ,腹膜后未见肿大淋巴结。CT示 :食管中段见不规则管壁增厚 ,形成肿物 ,最大截面约 4.0 cm,管腔变窄 ,7区可见 1 .5 cm肿大淋巴结 ;右肾上极见约 4.5 …     

CT仿真支气管内窥镜在中央型肺癌诊断中的应用

目的：评价螺旋CT仿真支气管内窥镜（CTVB）在中央型肺癌诊断中的作用。方法对45例经纤维支气管检查和病理证实的气管、支气管肿瘤患者进行CT仿真内窥镜检查，包括中央型肺癌33例、肺癌术后8例，肺癌放疗后2例及气恶性肿瘤2例。用新型螺旋CT机对患者进行扫描后，将数据建成CTVB图像进行分析，并与纤维支气管镜进行对照，24例与病理标本进行对照。结果CTV显示了100％的段以上支气管和80％以上的亚段支气管，肿瘤呈块状或结节状，引起管腔狭窄或闭塞。肺癌术后正常的支气管残端呈光滑的盲端，肿瘤复发呈结节状突出，与纤维支气管镜所见基本一致，肺癌放疗后支气管腔轻度凹凸不平及管腔狭窄，结论CTVB是一种新的无创性观察气管、支气管腔的方法、酷似纤维支气管镜所见，结合其他三维重建功能，能同时显示管壁的厚度和肿瘤向管腔外侵犯的范围，但与纤维支气管镜相比，不易观察支气管黏膜的表浅病变且不能活检。     

食管癌螺旋CT征象与癌组织中EGFR、PCNA表达间的关系

目的 探讨食管癌螺旋CT征象与癌组织中表皮生长因子受体(EGFR)、增殖细胞核抗原(PCNA)表达的关系。方法 选取110例食管癌患者，根据手术病理结果将患者分为低分化组36例、中分化组49例及高分化组25例，所有患者术前均行螺旋CT增强扫描，分析食管癌患者螺旋CT征象与手术切除癌组织标本中EGFR、PCNA表达的相关性。结果 食管癌患者螺旋CT征象中，病变长度>50 mm者EGFR、PCNA表达阳性率均高于病变长度≤50 mm者(P<0.05);管壁增厚>10 mm者EGFR、PCNA表达阳性率均高于管壁增厚≤10 mm者(P<0.05);管腔重度狭窄者EGFR、PCNA表达阳性率均高于轻度狭窄及中度狭窄者(P<0.05);有淋巴结转移者EGFR、PCNA表达阳性率均高于无淋巴结转移者(P<0.05);食管癌患者第一期、第二期螺旋CT值与EGFR、PCNA阳性率呈正相关(P<0.05)。结论 食管癌患者螺旋CT可清楚反映病变长度、管腔厚度、管腔狭窄程度、淋巴结转移及局部浸润情况，增强扫描的CT值与EGFR、PCNA的阳性表达率有关，将螺旋CT...     

输尿管中段转移性前列腺癌一例

患者男性,74岁.因排尿不畅5天、尿潴留3天,于1990年5月28日入院。检查:心肺正常,浅表淋巴结不肿大。肛指检查:前列腺Ⅱ°增大、无结节。B超示前列腺增生,左肾盂积水伴输尿管上段扩张。静脉肾盂造影:左肾未显影。膀镜镜检查:前列腺中度增大。左肾盂逆行造影见输尿管中段有一长约2cm的狭窄段。同年6月14日手术探查,见左髂总动脉分叉处下方1cm处输尿管管壁增厚,僵硬和周围组织粘连,上端输尿管扩张。探查膀胱未见占位病变。行输尿管部分切除端端吻合及前列腺摘除术。标本镜下观:前列腺的大部分结构被破坏,癌细胞部分形成腺管,部分呈筛状、条索状或散在分布在间质内,个别腺腔内可见嗜酸性分泌物或由分泌物聚成的淀粉样小体。输尿管移行上皮正     

食管癌高/低发区食管癌、贲门癌及胃癌检出率比较

[目的]比较食管癌高/低发区食管癌、贲门癌和胃癌检出率,进一步了解遗传和环境因素对食管和贲门癌变的影响。[方法]选择食管癌高发区河北磁县及河南安阳市肿瘤医院就诊患者6864例,低发区河南濮阳市人民医院就诊患者6682例,所有患者均行电子胃镜检查,分析各疾病的检出情况。[结果]高发区食管癌、贲门癌和胃癌分别检出1294例、520例和43例,低发区分别检出482例、165例和146例。高/低发区男性食管癌检出率均高于女性。且高发区食管癌、贲门癌、胃癌的家族史阳性率均显著性高于低发区（P均〈0.05）。[结论]食管癌的发生是环境因素与遗传因素相互作用的结果,探讨高/低发区致癌因素的差异,可为食管及贲门病变的发病机制及预防提供依据。     

盆腔四野钟摆外照射治疗宫颈癌

目前我国放射治疗宫颈癌的常规方法是腔内配合体外放射。其中腔内放射主要针对宫颈、宫体、阴道及其邻近的宫旁组织(即病变原发区)。但如果病变已属晚期(膀胱及直肠侵犯或已有远处转移);或有严重心、肝、肾等疾患;或患者解剖结构异常(阴道狭窄或畸形、子宫脱垂、宫颈残端癌、宫颈癌手术不彻底或术后复发等),则不宜采用     

一名七岁家族性高胆固醇血症患儿的心肌梗死

本文报道一例7岁半的家族性纯合子高胆固醇血症女性患儿,在经过饮食控制及降低胆固醇药物治疗后,未能达到胆固醇水平的持久下降。经过3次LDL去除术治疗后出现贫血。该患儿以后发生急性心肌梗死征象,心电图示亚急性前间壁心肌梗死,选择性冠状动脉造影显示严重的冠状动脉3支病变伴主干狭窄及左心功能明显受限,EF为27％。检查结束后出现血压下降伴心动过缓,需做紧急主动脉-冠状动脉旁路移植术(冠状动脉搭桥术)。尽管采取上述措施,患儿仍死于抗儿茶酚胺性心源性休克。 讨论 本例证实了这样一个已知事实,家族性纯合子高     

Early atherosclerosis and Chlamydia pneumoniae infection in the coronary arteries

In non-atheromatous segments of coronary arteries a sequence of preatherosclerotic changes was identified which consisted of medial thickening followed by intimal thickening. More recently, Chlamydia pneumoniae seropositivity was associated with enhanced intima-media thickness of arteries. In the present study the intimal and medial thickness of coronary artery of young adults were measured, and were correlated with the presence of Chlamydia pneumoniae antigens. Proximal and distal segments of the left anterior descending coronaries (LAD) obtained at autopsy from young adults (15-34 years) were studied. The thickness and cellular density of the intima and of the media without clear-cut atherosclerotic changes were measured by image analysis. The hypertrophy index was calculated as the ratio of cell density and the thickness of the respective layer. Atherosclerotic lesions occurring elsewhere in the same coronary were noted and graded by severity. The presence of Chlamydia pneumoniae verified by immunohistochemistry was correlated with the severity of lesions and with the hypertrophy index. In the proximal segments, atherosclerosis of LAD was associated with the widening of both the intima and the media of lesion free-sites. In the distal coronary segments the proportion of the intimal thickening had a significant association with atherosclerosis. Compared to non-infected arteries, Chlamydia pneumoniae infection was associated with higher hypertrophy index in the intima as well as in the media. The rate of Chlamydia pneumoniae positivity increased with the severity of lesions. As a conclusion: in the LAD coronary, the intimal thickening is the main preatherosclerotic change. Chlamydia pneumoniae may favour arterial wall hypertrophy and plays a role in lesion progression.     

左侧乳腺癌改良根治术后切线野放疗中心脏最大距离预测心脏剂量探讨

目的 探讨用切线野心脏最大距离(MHD)来预测左侧乳腺癌心脏照射剂量的可行性。方法 以2010—2011年在我院行辅助性左胸壁切线野放疗的40例左侧乳腺癌改良根治术后患者为研究对象,对每位受试对象用3D TPS计算MHD,全心脏、冠状动脉左前降支、左心室及心前区D_mean以及对侧乳腺组织厚度和胸骨至体表厚度。用曲线拟合方法分析MHD与上述各D_mean相关性,R2>0.8为可靠性非常好。结果 40例患者中MHD在1.14~5.34 cm之间^[(2.67±0.98) cm]。MHD与全心脏D_mean的拟合一次、二次和三次方程的R2值分别为0.869、0.875和0.883(3个P=0.000),与心前区D_mean的分别为0.777、0.799和0.813(3个P=0.000),与左心室D_mean的分别为0.598、0.601和0.633(3个P=0.000),与冠状动脉左前降支D_mean的分别为0.418、0.470和0.472(3个P=0.000)。心脏各D_mean不受身体脂肪厚度影响。结论 该模型提示MHD是预测左侧乳腺癌切线野放疗中全心脏、心前区D_mean的可靠指标。     

The effect of external electron beam on neointima in rat carotid artery injury model.

PURPOSE: Endovascular irradiation with either a gamma or a beta source has shown to reduce neointimal proliferation. However, the effect of external-beam radiation on neointimal hyperplasia is controversial. The objective of this study was to determine the effect of external-beam irradiation with different doses on neointimal hyperplasia in the rat carotid artery injury model. METHODS AND MATERIALS: Twenty-seven Sprague-Dawley rats underwent endothelial denudation injury by 2F Fogarty balloons on carotid artery. Immediately after the injury, rats were irradiated externally using 6-MeV electrons. Rats were grouped according to the radiation doses, 0 Gy as controls (n = 5), 5 Gy (n = 5), 10 Gy (n = 5), 15 Gy (n = 6), and 20 Gy (n = 6). Then, rats were sacrificed after 2 weeks and the carotid arteries were perfusion-fixed in paraformaldehyde. External elastic lamina (EEL) area, lumen area, maximal intimal thickness (MIT), and intimal area (IA) of the injured segments were measured on the basis of histomorphometry. RESULTS: In EEL and lumen area, there was no statistically significant difference between the irradiated groups and the controls. In MIT and IA, low-dose radiation (5 Gy and 10 Gy) did not induce any significant reduction. High-dose radiation (15 Gy and 20 Gy), however, reduced MIT and IA significantly. CONCLUSION: External electron beam reduced the intimal area, and the inhibition of neointimal proliferation was dependent upon radiation doses. This study suggests that the minimal effective dose for the inhibition of neointimal hyperplasia following denudation injury in the rat carotid model is between 10 Gy and 15 Gy.     

Myocardial perfusion changes in patients irradiated for left-sided breast cancer and correlation with coronary artery distribution

PURPOSE: To evaluate postradiation regional heart perfusion changes with single photon emission tomography (SPECT) myocardial perfusion imaging in 69 patients treated with tangential photon beams radiation therapy (RT) for left-sided breast cancer. To correlate SPECT changes with percent irradiated left ventricle (LV) volume and risk factors for coronary artery disease (CAD). METHODS AND MATERIALS: Rest SPECT of the LV was acquired pre-RT and at 6-month intervals post-RT. The extent of defects (%) with a severity > 1.5 standard deviations below the mean was quantitatively analyzed for the distributions of the left anterior descending (LAD) artery, left circumflex (LCX) artery, and right coronary artery (RCA) based on computer assisted polar map reconstruction (i.e., bull's-eye-view). Changes in perfusion were correlated with percent irradiated LV receiving > 25 Gy (range 0-32%). Data on patient- and treatment-related factors were collected prospectively (e.g., cardiac premorbidity, risk factors for CAD, chemotherapy, and hormonal treatment). RESULTS: In the LAD distribution, there were increased perfusion defects at 6 months (median 11%; interquartile range 2-23) compared with baseline (median 5%; interquartile range 1-14) (p < 0.001). There were no increases in perfusion defects in the LCX or RCA distributions. In multivariate analysis, the SPECT perfusion changes in the LAD distribution at 6 months were independently associated with percent irradiated LV (p < 0.001), hormonal therapy (p = 0.005), and pre-RT hypercholesterolemia (p = 0.006). The SPECT defects in the LAD distribution at 12 and 18 months were not statistically different from those at 6 months. The perfusion defects in the LAD distribution were limited essentially to the regions of irradiated myocardium. CONCLUSION: Tangential photon beam RT in patients with left-sided breast cancer was associated with short-term SPECT defects in the vascular distribution corresponding to the radiation portals. Factors related to the extent of perfusion defects included the percent irradiated LV, hormonal treatment, and pre-RT hypercholesterolemia.     

类胰蛋白酶在冠心病患者尸检心脏组织中的表达

目的探讨类胰蛋白酶(tryptase)与冠心病病情及与冠状动脉病变程度的关系。方法从本教研室2008～2011年尸检档案中挑选病例及心脏标本共70例。分为四组:A组:冠心病猝死(SCD,20例);B组:冠心病非猝死者(CHD,20例);C组:过敏性猝死(10例);D组:阴性对照(无明显动脉粥样硬化病变的死者,20例)。应用免疫组化染色(SP法)和图像定量分析法,观察每例左心室缺血心肌的类胰蛋白酶染色情况和光密度。结果 SCD组、CHD组、过敏性猝死组光密度值均高于阴性对照组,各组间比较均有显著差异(P<0.01)。结论缺血心肌中类胰蛋白酶的表达增加与SCD的发生密切相关,为SCD的诊断和临床对冠心病防治的研究提供新的途径。     

Analysis of coronary artery dosimetry in the 3-dimensional era: Implications for organ-at-risk segmentation and dose tolerances in left-sided tangential breast radiation

PurposeTo evaluate the dose to the left anterior descending artery in patients receiving left-sided tangential breast radiation.Methods and MaterialsThe study cohort consisted of 50 left-sided breast cancer patients who were sequentially simulated at our institution. The heart and left anterior descending (LAD) artery were contoured from its origin on the left main coronary artery down to the last visible segment of the vessel. Detailed dosimetry of the heart and LAD artery were obtained and analyzed.ResultsExcellent correlation between the dose to the heart and LAD artery was discovered. The mean LAD dose was 17.98 Gy. The mean dose to the proximal LAD was 2.46 Gy. The median V25 was 2.91% and the mean heart dose 3.10 Gy. For every 100 cGy increase in mean heart dose, mean LAD dose increased by 4.82 Gy. For every percent increase in the heart V10 and V25, there was a 2.23 Gy and 2.77 Gy increase in mean LAD dose, respectively. For every percent increase of heart V25, a 5.6% increase in the LAD V20 was demonstrated.ConclusionsThe LAD artery dose correlates very closely with all of the commonly measured heart dose constraints, and does not need to be contoured separately when standard tangential borders are used. Incidental LAD artery doses remain with supine breast tangential radiation therapy.     

Dosimetric comparison between high-precision external beam radiotherapy and endovascular brachytherapy for coronary artery in-stent restenosis

PURPOSE: Several drawbacks of endovascular brachytherapy for the treatment of coronary artery in-stent restenosis may be addressed by high-precision external beam radiotherapy (EBRT). The dosimetric characteristics of both treatment techniques were compared. METHODS AND MATERIALS: The traversed volume of 10 coronary artery stents during the cardiac cycle was determined by electrocardiographically gated multislice spiral CT in 10 patients. By use of this traversed volume, high-precision EBRT treatment plans were generated for stents in the left circumflex (LCx), left anterior descending (LAD), and right coronary artery (RCA). The maximum dose to the nontargeted major coronary arteries was determined and compared to similar data calculated for endovascular brachytherapy. RESULTS: High-precision EBRT targeted at LCx stents contributed a mean maximum dose (D(max)) of 83.5% (range: 71.6-95.3%) and 16.3% to the LAD and RCA, respectively. Targeted LAD stents contributed a mean D(max) of 39.3% (range: 14.5-94.8%) and 5.2% (range: 0-13.4%) to the LCx and RCA, respectively. Targeted RCA stents contributed a mean D(max) of 6.2% (range: 0-12.4%) and 5.8% (range: 0-11.5%) to the LCx and LAD, respectively. Endovascular brachytherapy targeted at LCx stents contributed a mean D(max) of 1.7% (range: 0.7-2.7%) and 1.0% (range: 0.6-1.4%) to the LAD and RCA, respectively. Targeted LAD stents contributed a mean D(max) of 5.2% (range: 0.5-11.4%) and 0.7% (range: 0.4-1.1%) to the LCx and RCA, respectively; targeted RCA stents contributed a mean D(max) of 0.3% (range: 0.2-0.5%) and 0.2% (range: 0.1-0.3%) to the LCx and LAD, respectively.CONCLUSIONS: Although the doses distributed throughout the heart were higher for high-precision EBRT compared to endovascular brachytherapy, they are expected to be clinically irrelevant when nontargeted major coronary arteries are not closely situated to the targeted vessel segment. These encouraging results warrant further investigation of high-precision EBRT as a potential alternative to endovascular brachytherapy for the treatment of coronary artery in-stent restenosis.     

Acute coronary thrombosis and myocardial ischemia following chemotherapy of Hodgkin's disease

A 37 year old man without coronary risk factors or known heart disease showed progression of Hodgkin's disease after radiation and multiple chemotherapy. One day after the first cycle of chemotherapy with methotrexate, Ifosfamide and etoposide, he had an acute myocardial ischemia. The creatinin-kinase was elevated up to 325 U/l. Coronary angiography showed a thrombus in the left anterior descending coronary artery (LAD), while the other coronary arteries were normal. Ventriculography showed an apical akinesia. After 7 days of treatment with heparin coronary angiogram was normalized, without any stenosis in the LAD. To our knowledge this is the first documented case of a coronary artery thrombosis and myocardial ischemia after chemotherapy in a patient without coronary heart disease. We conclude that chemotherapy can cause myocardial ischemia by coronary artery thrombosis in patients without prior heart disease.     

Short term arterial remodelling in the aortae of cholesterol fed New Zealand white rabbits shown in vivo by high-resolution magnetic resonance imaging — implications for human pathology

High-resolution, non-invasive imaging methods are required to monitor progression and regression of atherosclerotic plaques. We investigated the use of MRI to measure changes in plaque volume and vessel remodelling during progression and regression of atherosclerosis in New Zealand White rabbits. Atherosclerotic lesions were induced in the abdominal aorta by balloon injury and cholesterol feeding. MR images (2D) of the abdominal aorta were acquired with cardiac and respiratory gating using a fast spin echo sequence with and without fat-suppression. In an initial study on rabbits treated for 30 weeks we imaged the aortae with a spatial resolution of 250x250 micrometers with a slice thickness of 2 mm and achieved a close correlation between MRI-derived measurements and those made on perfusion pressure-fixed histological sections (r(1) = 0.83, slope p(1) < 0.01). We subsequently imaged 18 rabbits before and periodically during 12 weeks of cholesterol feeding (progression) followed by 12 weeks on normal diet (regression). Aortic wall (atherosclerotic lesion) volume increased significantly during progression and decreased during regression. In contrast, lumen volume increased during progression and did not change during regression. In conclusion, this study confirms that non-invasive, high-resolution MRI can be used to monitor progression and regression of atherosclerosis, each within 3 months and shows, for the first time in a short-term model, that positive remodelling occurs early during progression and persists through regression of atherosclerotic lesions.