宫颈癌供血动脉灌注化疗及栓塞选择

目的　探讨宫颈癌子宫动脉灌注栓塞的临床应用价值。方法　 78例经病理证实的宫颈癌 ,分期为 :Ⅰ期 13例 ,Ⅱ期 2 8例 ,Ⅲ期 2 2例 ,Ⅳ期 4例 ,残端癌 3例 ,多次放化疗无效 8例。所有病例做子宫动脉选择性插管行灌注栓塞治疗。结果　有效率为82 .1% ,治疗后 2 8例行广泛性全宫切除术 ,2 7例做放射治疗 ,8例做全身化疗。治疗后有 3例出现阴道宫颈破溃 ,急性肾功能衰竭1例 ,尿失禁 2例。结论　子宫动脉灌注栓塞是宫颈癌有效的辅助治疗方法。     

大肠癌的血管造影诊断和灌注化疗(附35例分析)

大肠癌是消化道常见恶性肿瘤,发病率逐年增加。大肠癌的诊断和治疗已引起国内外的重视。本文收集我院近4年来经选择性血管造影、抗癌药物动脉灌注、手术或/和病理证实的大肠癌35例作一分析,着重订论大肠癌的血管造影诊断和灌注化疗价值。     

支气管动脉灌注紫杉醇联合全身化疗治疗晚期非小细胞肺癌

目的 观察选择性经支气管动脉灌注紫杉醇（泰素）及卡铂并联合紫杉醇全身化疗治疗晚期非小细胞肺癌（NSCLC）的疗效及不良反应。方法 对57例晚期NSCLC患者经支气管动脉注入紫杉醇和卡铂,同时予紫杉醇全身化疗,每例均完成2－3周期后评价其疗效及不良反应。结果 57例中完全缓解（CR）6例,部分缓解（PR）28例,总有效率59．6％。主要不良反应为骨髓抑制、胃肠道反应、脱发等,不良反应多为Ⅰ－Ⅱ度。结论 经支气管动脉灌注紫杉醇和卡铂并联合紫杉醇全身化疗是治疗晚期非小细胞肺癌的一种有疗效好、不良反应可耐受的方案。     

超选择膀胱动脉化疗栓塞治疗中晚期膀胱癌

目的：采用经导管超选择性膀胱动脉化疗栓塞治疗中晚期膀胱癌并探讨其疗效。技术要点及并发症。方法：15例经病理证实的中晚期膀胱癌,经两侧膀胱动脉局部灌注化疗,然后用碘油加5－氟尿啶及明胶海绵碎屑作.结果：CR＋PR为13例（13／15）,NC为2例（2／15）,总有效率为86．7％,4例获II期手术切除,结果：采用经导管超选择膀胱动脉化疗栓塞昌治疗中晚期膀胱癌的一种有效方法,部分患者还可获得II期手术机会,能明显提高患者的生存率。     

选择性支气管动脉内药物灌注或加栓塞治疗中晚期肺癌

本文报道49例中晚期肺癌患者,经选择性支气管动脉药物灌注治疗及无水酒精栓塞共计74次,所有患者经病理检查证实,其临床分期,Ⅱ期11例,Ⅲ期18例,Ⅳ期15例,肺转移癌5例。近期有效率为93.9％。并对灌注的方法,提高插管成功率,与化疗效果有关的诸因素及预防并发症等问题,作了具体介绍和探讨。     

术前两种化疗方式对晚期乳腺癌微血管及微淋巴管密度影响的比较

 目的 探讨术前区域动脉灌注化疗及全身静脉化疗对晚期乳腺癌微血管密度(Microvessel demity,MVD)、微淋巴管密度(Microlymphtic vessel density,MLVD)的影响.方法 76例晚期乳腺癌患者随机分为2组,术前动脉灌注化疗组35例、术前全身静脉化疗组41例,选其中25例未行化疗前的乳腺癌组织作对照组.采用免疫组化SP法,用CD34、VEGFR3抗体检测3组乳腺癌组织标本MVD、MLVD.结果 MVD术前动脉灌注化疗组为(36.05±13.64),术前全身静脉化疗组为(49.92±12.90),对照组为(60.38±13.54),各组间比较差异有统计学意义(P＜0.01);MLVD术前动脉灌注化疗组为(6.62±3.70),术前全身静脉化疗组为(9.96±4.57),对照组为(11.30±5.32),动脉灌注化疗组与对照组比较显著下降(P＜0.01),与静脉化疗组比较差异有统计学意义(P＜0.05),静脉化疗组与对照组比较差异无统计学意义(P＞0.05).结论 术前区域性动脉灌注化疗比全身静脉化疗更能有效降低肿瘤组织及其周边组织内MVD和MLVD,从而抑制肿瘤细胞生长,减少肿瘤转移的机会.     

超选择性支气管动脉栓塞化疗治疗肺癌

目的　探讨超选择性支气管动脉栓塞化疗治疗肺癌的安全性和疗效。方法　回顾分析32 9例经病理学诊断的肺癌作单纯支气管动脉灌注化疗和超选择性支气管动脉栓塞化疗的资料。(1)单纯支气管动脉灌注化疗组 (2 2 1例 ) :普通导管插至支气管动脉主干或肋间 支气管动脉干造影后 ,经导管注入顺铂 4 0～ 6 0mg或卡铂 2 0 0～ 30 0mg ,联合用丝裂霉素 10～ 2 0mg或鬼臼乙叉甙 10 0～ 2 0 0mg。间隔 2～ 4周再次灌注化疗 ,2 2 1例共行 5 4 9次。 (2 )超选择性支气管动脉栓塞化疗组(10 8例 ) :普通导管插管造影后 ,在路图成像指引下 ,将微导管超选择性插至供瘤动脉近瘤处 ,经微导管注入抗癌药 (同单纯支气管动脉灌注化疗组 )和栓塞剂。栓塞剂选用 0 5～ 1 5mm3 明胶海绵颗粒30～ 5 0颗和 (或 )超液态碘油 3～ 8ml。间隔 6～ 9周再次作栓塞化疗 ,10 8例共行 2 6 6次。结果　 2组均未出现脊髓损伤等严重并发症。 2 2 1例单纯支气管动脉灌注化疗中 ,完全缓解 (CR) 2 8例 ,部分缓解 (PR) 79例 ,稳定 (S) 88例 ,进展 (P) 2 6例 ,有效率 (CR +PR)为 4 8 4 % ,1年生存率为 5 3 8% ,2年生存率为 4 4 8% ;10 8例超选择性支气管动脉栓塞化疗中 ,CR 16例 ,PR 5 3例 ,S 32例 ,P 7例 ,有效率为 6 3 9% ,1年生存率为 77 8% ,2年     

结直肠癌肝转移动脉化疗栓塞与全身静脉化疗的疗效对比分析

目的 通过比较经肝动脉灌注化疗栓塞与全身静脉化疗治疗结直肠癌肝转移的疗效及生存率,旨在为临床制定合理治疗方案提供依据.资料与方法 回顾性分析45例临床分期相同但治疗方法不同的结直肠癌患者资料,将其分为肝动脉化疗栓塞组及全身静脉化疗组.其中肝动脉灌注化疗栓塞治疗组27例,全身静脉化疗组18例.两组均采用Folfox方案化疗,治疗前后行血常规、肝肾功能及肝脏增强CT检查.随访其生存结果,分析两组的完全缓解(CR)、部分缓解(PR)及1、2、3年生存率.结果 肝动脉化疗栓塞组的CR、PR率(20%、35%)显著高于静脉化疗组(6.25%、25%)(P<0.05);肝动脉灌注化疗组的中位生存期为(25± 0.5)个月,明显高于全身静脉化疗组生存期(13±0.5)个月;肝动脉灌注化疗组的1、2、3年生存率(62.96%、48.14%、22.2%)也显著高于静脉化疗组(38.89%、16.67%、0%)(P<0.05).结论 肝动脉灌注化疗栓塞治疗结肠癌肝转移优于全身静脉化疗.     

乳腺癌DSA造影及术前超选择性动脉化疗栓塞

目的 探索乳腺癌的血供特点及术前超选择性动脉化疗栓塞的临床应用价值.方法 48例经穿刺活检确诊乳腺癌患者,采用术前DSA造影评估乳腺癌供血动脉分布,分别超选择性插管化疗栓塞.结果 48例患者DSA造影共发现74支明确供血动脉.单支供血9例,多支供血39例,主要以胸外侧动脉和(或)胸廓内动脉为主.灌注化疗后手术切除的近期...     

药物微囊对原发性肝癌肝动脉栓塞的实验及临床观察

本文选用3种抗癌药物(阿霉素、丝裂霉素、氟脲嘧啶)将其包裹于含钡乙基纤维素微囊中,经肝动脉注入后一方面阻断肿瘤的血供,另一方面释放出化疗药物,发挥靶向抗癌作用,降低全身毒副反应。实验犬灌注微囊前后的肝动脉造影表明,术后肝动脉分支减少,呈枯枝状。对20例原发性肝癌进行了61次肝动脉化疗及栓塞。10例用多“弹头”微囊栓塞治疗,10例作化疗药物灌注,微囊栓塞治疗明显优于单纯灌注法。     

胃癌中生长抑素表达的临床病理意义及DNA含量分析

应用免疫组化及图像分析技术观察１４０例组织学类型胃癌中生长抑素的表达，并随其中１２７例。     

A rare case of gliomatosis cerebri lurking beneath the shadows of a stroke mimic

Gliomatosis cerebri (GC) is a diffuse infiltrative neoplastic glial process with a devastating prognosis. Considering its rarity, unpredictable clinical manifestations, and lack of characteristic radiographic features, GC is a difficult diagnosis that is quite often delayed. In this report, we present a case of a 61-year-old man with a history of chronic alcohol abuse and atrial fibrillation who presented with right arm weakness initially presumed to be from an acute ischemic stroke. GC was not diagnosed until six months after initial symptoms and diagnosis was indicated when considering the neurocognitive findings in conjunction with suggestive radiographic findings. The presence of a rapid, expansile lesion in the cortex, corpus callosum, and infratentorial structures with mild parenchymal enlargement, as shown in our case, is more revealing of an invasive entity typical of GC rather than an ischemic process and other pathologies. This case demonstrates the fatal challenges of its prompt recognition and the therapeutic limitations for those patients presenting with advanced symptoms at the time of diagnosis. Recognizing GC in cases with such rapid multilobe clinical features with similar diffusely invasive patterns of growth on imaging can avoid a delay in diagnosis and improve patient quality of life.     

CT and MRI findings in gliomatosis cerebri: a neuroradiologic and neuropathologic review of diffuse infiltrating brain neoplasms

The aim of the study was to develop objective criteria that might be helpful for the diagnosis of gliomatosis cerebri (GC) with the highest possible probability based on both the neuroradiological and histopathological findings. Imaging findings in 14 patients with diffuse infiltrating brain neoplasms were studied by two neuroradiologists. Computed tomography and MRI scans were compared with each other side by side. The extent and kind of disease were graded on a scale of 1–5. Interexamination agreement between the two methods was calculated using a kappa analysis. Neither of the neuroradiologists performed the examinations and both were blinded to the histopathological findings, which were also available for all patients, based on biopsy as well as follow-up CT and MRI studies. A neuroradiological–neuropathological correlation was performed. A score system helped to differentiate the findings in three categories: 1 = suggestive of GC; 2 = GC cannot be excluded; and 3 = others. Both CT and MRI were performed in 14 patients with clinical signs and symptoms of an intracerebral tumor. All examinations had diagnostic quality and showed the involvement of at least two brain lobes. Stereotactic biopsy was carried out in all patients. In 2 patients the neuropathological diagnosis was suggestive of GC, in 1 patient glioblastoma, in 2 patients astrocytoma, and in 5 patients nonspecific astrogliotic proliferation. In the remaining 4 cases anaplastic tumor infiltration was diagnosed. The neuroradiological findings in 5 cases were suggestive of GC; in 6 cases a GC could not excluded; and in 3 patients only a slight probability of GC was found. In 2 cases was the neuropathological and the neuroradiological diagnosis of GC concordant. Magnetic resonance imaging is significantly more sensitive than CT in the diagnosis of GC. However, even with multiple, MRI-guided stereotactic biopsies in correlation with intraoperative analysis of the sample by smear preparations by a neuropathologist the antemortem diagnosis of GC is still difficult. Discussion of neuropathological and neuroradiological findings in each case in combination with a score system may help to resolve discrepancies. Received: 3 March 2000/Revised: 1 August 2000/Accepted: 4 August 2000     

Immunostimulatory properties of glycated chitosan

Glycated chitosan (GC) is a new compound derived from chitosan by attaching galactose molecules to the chitosan molecules. GC was designed for immune stimulations in combination with phototherapies in the cancer treatment. The future clinical applications require a thorough understanding of the properties of GC. Murine macrophage cells (RAW264.7) were used to investigate NO formation and TNFα secretion stimulated by GC. Murine mammary tumor cells (EMT6) were treated in vitro and in vivo by laser irradiation with 980 nm in combination with GC stimulation. Here is the first in a series of studies designed to understand the immunological mechanisms of GC. Our in vitro results show that GC could enter into macrophages to stimulate NO generation and TNFα secretion. GC could further enhance the TNFα secretion of macrophages stimulated by laser treated tumor cells. Our in vivo results also show immunological effects of GC, particularly in inducing tumor-specific immune responses. Our results indicated that GC was a strong immunological stimulant for cancer treatment, particularly when combined with laser phototherapies.     

Gliomatosis cerebri: findings with computed tomography and magnetic resonance imaging

Gliomatosis cerebri (GC), is a rare neoplastic disease (less than 150 cases reported in the literature) with a diffuse, widespread proliferation of neoplastic glial cells in the brain, generally affecting both hemispheres and involving the gray and white matter 1, 2, 3. Less commonly, the cerebellum, the brain stem and the medulla can be affected. Histologic evaluation reveals neoplastic astrocytes with varying levels of differentiation. Perineuronal and perivascular spread of tumor infiltration is observed. Demyelination can be found in the affected areas. A well-preserved underlying neuroanatomic architecture is considered characteristic [2]. Clinical signs vary and are non-specific, including changes in the mental state and headaches, followed by focal motor deficits and convulsive episodes [4]. The prognosis is poor, ranging from weeks to some years after the manifestation of the symptoms. Steroids may be useful in the short term, but chemotherapy is of little value and radiotherapy of questionable benefit. The literature was reviewed and the radiological pattern of three new cases of GC is reported. In two cases the diagnosis was achieved ante-mortem.     

131I联合糖皮质激素治疗Graves眼病疗效的Meta分析

目的 对131I+糖皮质激素（GC）治疗Graves眼病（GO）进展的有效性和安全性进行系统评价。 方法 检索PubMed、Embase、Cochrane Library和中国知网、万方数据知识服务平台中关于131I+GC治疗GO的相关研究,检索时间从建库至2021年7月20日。根据纳入和排除标准筛选文献、提取数据。应用Stata 15.0软件进行Meta分析,比较131I+GC治疗与单纯131I治疗对不同时期 Graves 甲状腺功能亢进症（GH）合并GO患者的疗效,并分析静脉注射与口服GC 2种用药方式对GO治疗及其并发症发生情况的影响。采用χ2检验的P值和 I2对文献进行异质性评价,GO病情进展情况用相对危险度（RR）表示,采用Egger法和剪补法对纳入文献的发表偏倚和敏感性进行分析,采用Z检验分析2种用药方式的治疗效能。 结果 最终纳入22篇文献,其中15篇文献为随机对照试验类,7篇文献为队列研究类。131I+GC治疗较131I治疗对GH合并GO患者的疗效更佳,差异有统计学意义（Z=3.18,RR=0.37,95%CI:0.20~0.68,P=0.004）;标准剂量GC（0.3~0.5 mg/kg）较低剂量GC（0.2~0.3 mg/kg）能更好地预防GO的进展。不同的用药方式对预防GO进展的影响不大。 结论 131I+GC治疗对预防GH合并GO患者的病情进展是有效的,特别是活动期的GO患者;标准剂量GC较低剂量GC能更好地控制GO的进展,但同时产生更多的并发症;静脉注射与口服GC 2种用药方式对131I治疗后的GO患者疗效相当。     

胃癌中神经内分泌细胞的临床病理意义

应用组织学，免疫组化，透射电镜对１８９例各组织学类型胃癌的神经内分泌（ＮＥ）细胞进行观察，并对其中１２７例患者进行随访。８５例检出ＣｇＡ阳性癌细胞（４５．０％），其中７３例进一步做各类激素抗体检测，所采用的９种激素抗体在胃癌组织中均有阳性表达。ＮＥ阳性癌细胞多出现在分化差的胃癌组织学类型中（Ｐ＜０．０１），某些激素种类的表达与胃癌组织学类型及分化关系较密切。ＮＥ阳性胃癌组４０例的淋巴结转移癌灶中１９例有转移ＮＥ阳性细胞，其中１３例ＨＣＧ表达阳性（６８．４２％），明显高于其他激素的阳性表达（１０％～３１．６％，Ｐ＜０．００１）。胃癌中产生某些激素与患者存活期有关。上述结果提示：胃癌中某些ＮＥ细胞分泌的激素产物可能对胃癌浸润转移及预后有较重要的影响。     

CA242和PTEN蛋白在胃癌和癌前期病变组织中的表达及其意义

目的：探讨CA242和PTEN蛋白在胃腺癌组织（GC）中的表达及其意义。方法：应用免疫组化技术检测120例GC、30例非典型增生组织（DPGM）和20例正常胃黏膜组织（NGM）中CA242和PTEN蛋白表达水平，并结合肿瘤的病理学行为和临床随访资料分析。结果：在GC组织中，CA242和PTEN蛋白表达阳性率分别为79．2％（95／120）和48．3％（58／120）。GC中CA242表达阳性率明显高于DPGM（P〈0．05），PTEN表达阳性率则明显低于DPGM和NGM（P〈0．05）。CA242高表达和PTEN低表达与GC浆膜浸润、淋巴结转移和患者预后相关（P〈0．05）。CA242表达与PTEN表达呈显著负相关（P〈0．05）。结论：CA242和PTEN表达与GC发生、转移和患者生存期密切相关，检测CA242和PTEN蛋白表达可作为判断GC预后的参考指标。     

帕米膦酸二钠(博宁)合并化疗缓解多发性骨髓瘤骨痛疗效观察

目的评价帕米膦酸二钠 (博宁 )在缓解多发性骨髓瘤患者骨痛中的作用。方法应用博宁联合化疗1 6例与单纯化疗 1 8例进行对照研究。结果博宁联合化疗与单纯化疗均能显著减轻多发性骨髓瘤患者的骨痛程度 (与治疗前比较P <0 .0 1 ) ,博宁联合化疗对骨痛的缓解程度强于单纯化疗 (P <0 .0 5 )。在应用博宁的病例中 ,除 1例出现轻度发热外未见明显毒副作用发生。结论博宁是一种安全有效的双膦酸盐制剂 ,与化疗联合应用可以显著缓解多发性骨髓瘤患者的骨痛。