MSCT对胃癌的诊断价值及晚期胃癌介入治疗的探讨(附48 例病例分析)

目的探讨多层螺旋CT对胃癌的诊断价值及介入治疗的适应证。方法回顾分析48例经病理证实的胃癌的多层螺旋CT表现及10例介入治疗的疗效观察。结果主要CT征象为胃壁增厚、僵硬、肿块。动脉期及门静脉期病变明显强化,40例以门静脉期更著;周围脏器浸润和淋巴结转移各18例,远处转移15例;增强分期准确性87.5％;介入治疗10例均延长寿命。结论多层螺旋CT增强可对胃癌作出更为完善的评价,有助于胃癌的诊断及分期;介入治疗是晚期胃癌患者延长生命较有效的方法。     

Laparoscopic adrenalectomy for a late solitary renal cell cancer metastasis to the ipsilateral adrenal gland

Background

Metastases to the adrenal gland are the second most common type of adrenal mass lesion after adrenocortical adenomas [1, 2]. However, less than 2% of those patients who develop a metachronous metastasis after resection of a primary renal tumour will present with a solitary adrenal tumour [3]. Most of these patients present within several years of the primary diagnosis [4].

Case report

A 66-year-old man with a history of left nephrectomy for renal cell carcinoma 18 years previously was investigated for recent weight loss. Computed tomography scanning identified a lesion in the ipsilateral adrenal gland. Hormonal investigations were consistent with a non-functioning mass. Magnetic resonance imaging and positron emission tomography scans suggested a malignant lesion. Laparoscopic adrenalectomy was performed without complication and histopathological examination confirmed metastatic renal cell carcinoma. The patient remains well with no evidence of recurrence at 6 months.

Conclusion

Laparoscopic adrenalectomy is a safe, effective treatment in the treatment of late solitary renal cell cancer metastasis to the ipsilateral adrenal gland.     

应重视肺癌的基础研究

肺癌是严重威胁人类健康的重大疾病,世界上肺癌已成为病死率第1位的恶性肿瘤。根据WHO估计,到2025年我国每年新增的肺癌病死例数将超过100万;到2030年全球每年将有1000万人死于肺癌。肺癌是预后最差的恶性肿瘤之一,虽经几十年的努力,投入大量的人力、物力到肺癌的诊治工作,但肺癌的总体5年生存率在美国仅为15％,我国则更低。与50年前相比,主要威胁人类健康的疾病如心脏病、脑血管病和感染性疾病已下降约2／3,但肺癌以年龄调整的死亡率却不断攀升。     

血清NSE,CEA和β2-MG含量对小细胞肺癌的诊断价值

0 引言肺癌是近几年来发病率日趋增高,严重危害人类健康的常见恶性肿瘤之一. 神经元特异性烯醇化酶(NSE)是特异定位于神经元的糖酵解酶,是神经母细胞瘤的肿瘤标志物 . 由于小细胞肺癌是最常表现有神经内分泌性质的肿瘤,故NSE也是目前认为SCLC最敏感、最特异的肿瘤标志物. 国内目前用联合测几种肿瘤标志物对SCLC进行诊断的报道还较少,为此我们采用免疫分析法检测了SCLC,NSCLC和肺部良性疾病患者血清中NSE,CEA和β2-MG含量,以对比探讨其临床价值.     

目标教学是提高教学质量的有效途径——淡谈目标教学模式的四个环节

目的：探讨目标教学的新模式。方法：介绍“前提测评——认定目标——导学达标——达标测评”四个环节。结果：克服了以往学生学习的盲目性，提高了课堂教学效果，从而提高教学质量。结论：目标教学是课堂教学的一项综合改革，是推测素质教育的一条有效途径，也是提高教学质量的有效途径。     

CT引导下经皮肺穿刺活检在中央型肺癌诊断中的应用

目的探讨CT引导下经皮肺穿刺活检对中央型肺癌诊断中的应用及并发症的预防。方法对29例经纤维支气管镜检查未确诊或无法接受纤维支气管镜检查的中央型占位病变患者行CT引导下经皮肺穿刺活检。对其穿刺成功率、组织病理学阳性率及并发症的发生进行回顾性分析。结果29例中,穿刺成功率为100％,组织病理学阳性率为100％。其中鳞癌15例,小细胞癌4例,腺癌4例,腺鳞癌6例。并发症发生率：气胸13．8％,针道出血1013％,咳血3．4％。结论CT引导下经皮肺穿刺活检术对纤维支气管镜检查阴性或无法接受纤维支气管镜检查的中央型肺癌诊断,是一种高效、准确、微创的定性诊断方法。     

千金子二萜醇衍生物抗非小细胞肺癌的作用及机制

目的：非小细胞肺癌占所有肺癌的85%,具有较高的发病率和病死率。非小细胞肺癌的治疗研究和新药开发迫在眉睫。本研究主要探讨千金子二萜醇衍生物的活性及其抑制非小细胞肺癌细胞生长的作用机制。方法：以千金子二萜醇为原料合成3个千金子二萜醇衍生物,采用磁共振验证结构;采用MTT法检测上述衍生物对非小细胞肺癌细胞(A549和H1299细胞)增殖活力的影响,筛选出活性最佳的化合物进行后续实验。集落形成、划痕、Transwell实验分别用于检测A549和H1299细胞的体外增殖、迁移和侵袭能力,实时荧光定量PCR(real-time RT-PCR)和蛋白质印迹法用于检测A549细胞中E-cadherin、N-cadherin、β-catenin、MMP2等mRNA和蛋白质的表达水平。结果：3个千金子二萜醇衍生物均呈剂量依赖性地抑制A549和H1299细胞的生长,且对正常细胞Beas-2B和16HBE细胞抑制作用较弱,具有一定的选择性杀伤作用。其中C-5苯甲酰化千金子二萜醇的活性最佳,作为后续实验的药物。与对照组相比,处理组的A549和H1299细胞克隆团明显变小且数目明显减少,相对迁移率明显降低,侵袭...     

头侧-中央联合入路与单纯头侧入路治疗右半结肠癌患者效果观察

目的 对比分析头侧-中央联合入路与单纯头侧入路治疗右半结肠癌患者的效果。方法 选取2016年1月至2018年12月收治的90例右半结肠癌患者随机分为观察组和对照组, 均采用腹腔镜手术治疗, 观察组采用头侧-中央联合入路, 对照组采用单纯头侧入路, 比较两组手术指标、术后恢复指标及并发症发生情况。结果 两组患者切除标本长度、清扫淋巴结数目差异无统计学意义(P＞0.05), 观察组患者手术时间较对照组显著缩短, 术中出血量较对照组显著降低, 差异具有统计学意义(P＜0.05), 观察组患者退热时间、术后排气时间、住院时间较对照组均显著缩短, 差异均具有统计学意义(P＜0.05), 观察组、对照组术后并发症发生率分别为6.67%、11.11%, 差异无统计学意义(P＞0.05)。结论 腹腔镜下头侧-中央联合入路半结肠癌根治术治疗右半结肠癌患者可缩短手术时间, 减少术中出血量, 安全可靠, 且能够促进患者术后恢复, 缩短住院时间, 值得在临床上推广。     

Increased apolipoprotein E gene expression and protein concentration in lung cancer tissue do not contribute to the clinical assessment of non-small cell lung cancer patients

BACKGROUND: We tested the hypothesis that apolipoprotein E (apo E) gene expression and protein concentration are increased in resectable non-small cell lung cancer tissue and that these apo E tissue estimations may be benefitially used in clinical assessment of non-small cell lung cancer patients. METHODS: Paired samples of lung cancer and adjacent, appartently healthy, non-cancer lung tissue were collected from 42 patients with resectable non-small cell lung cancer. Apo E gene expression in tissue was measured by quantitative PCR. Apo E protein in tissue and serum was quantified by a nephelometric method. Patients were followed for 3 years. RESULTS: Apo E gene expression and protein concentration were 1.6 and 4.1-fold higher in the cancer tissue than in the adjacent non-cancer tissue (p<0.0001 in both cases). Increase of apo E protein concentration in the cancer tissue (relative to the non-cancer tissue) correlated with the decrease of apo E protein concentration in the serum (p=0.021). However, none of these apo E estimations related to stage of cancer or histological type of tumor and do not predict patient survival. CONCLUSIONS: Our preliminary study shows that despite the distinct increase of apo E gene expression and protein concentration in the cancer tissue and the concurrent decrease of apo E protein concentration in the serum, the measured apo E values have limited usefulness in clinical assessment of patients with resectable non-small cell lung cancer.     

The right not to know: the case of psychiatric disorders

This paper will consider the right not to know in the context of psychiatric disorders. It will outline the arguments for and against acquiring knowledge about the results of genetic testing for conditions such as breast cancer and Huntington's disease, and examine whether similar considerations apply to disclosing to clients the results of genetic testing for psychiatric disorders such as depression and Alzheimer's disease. The right not to know will also be examined in the context of the diagnosis of psychiatric disorders that are associated with stigma or for which there is no effective treatment.     

经皮肺穿细胞学诊断肺癌的准确性探讨

目的 :通过细胞学形态观察 ,提高肺癌诊断的准确性。方法 :经皮行肺部病变穿刺。结果 :有组织学证实的 96例经皮肺穿病例中 ,84例与细胞学诊断完全相符 ,准确率达 87.5%。结论 :经皮肺穿细胞学诊断肺癌很有价值。     

Reduced expression of Bax in small cell lung cancer cells is not sufficient to induce cisplatin-resistance

Resistance to cisplatin in the course of chemotherapy contributes to the poor prognosis of small cell lung cancer (SCLC). B cell lymphoma-2 is the founding member of a large family of proteins that either promote or inhibit apoptosis. We aimed at investigating if the pro-apoptotic members Bad, Bax, Bim and Bid are involved in cisplatin-resistance. - Cisplatin-resistance in the SCLC cell line H1339 was induced by repetitive exposure to cisplatin. Protein expression was quantified by Western Blot and immuno-fluorescence analysis. Protein expression was altered using siRNA interference. - Four cycles of 0.5 μg/ml cisplatin led to partial cisplatin-resistance in H1339 cells. The expression of Bad, Bim and Bid was comparable in naive and resistant cells while the expression of Bax was reduced in the resistant clone. But, reducing Bax expression in naive cells did not lead to altered cisplatin sensitivity neither in H1339 nor in H187 SCLC cells. - We conclude that the reduced Bax expression after exposure to cisplatin is not sufficient to induce cisplatin-resistance in SCLC cells.     

CT引导下经皮肺穿刺活检术在肺部病变诊断中的应用

目的:分析CT引导下经皮肺穿刺活检术对肺部病变的诊断价值。方法:回顾性分析我院2015年1月~2016年12月期间行CT引导下经皮肺穿刺活检术的39例患者临床资料、穿刺方法、穿刺成功率、诊断准确性、敏感性以及并发症。结果:39例病人中37例穿刺成功,穿刺成功率94.87%,明确病理学诊断35例,肺部恶性病变28例,其中鳞癌12例,腺癌12例,小细胞肺癌1例,未分型肺癌3例。良性病变7例(结核2例,炎症4例,结缔组织病1例)。发生并发症6例,发生率15.38%。结论:CT引导下经皮肺穿刺活检术在肺部病变诊断中具有较大的应用价值,并发症可以防控,值得在临床推广。     

累及颅底肿瘤切除的两种途径

 目的 探讨完整而安全切除累及颅底区域肿瘤的两种手术径路。方法 对4例颅底肿瘤根据侵及区域不同,采用不同的手术径路,其中3例采用经一侧上颌骨翻转入路,1例采用经一侧腮腺颞下窝入路。结果 所有病例的颅底肿瘤均被安全而完整地切除,涉及的颅底区域包括颞下窝,翼腭窝,鼻咽部及咽旁间隙。病变包括纤维血管瘤,非霍奇金恶性淋巴瘤,高分化平滑肌肉瘤及高分化鳞癌。结论 上颌骨掀翻入路是治疗中颅底或侧颅底,尤其是同时累及两个解剖区域以上病变时一种较好的选择。对于侧后颅底病变伴张口受限,面神经受侵犯者,经腮腺颞下窝入路是极好的选择。     

CT引导下经皮穿刺植入125Ⅰ粒子组织间近距离治疗非小细胞肺癌的探讨

目的探讨CT引导下经皮穿刺植入125I粒子组织间近距离治疗非小细胞肺癌(NSCLC)的技术可行性、临床疗效和不良反应.方法植入治疗NSCLC 95例.所有病例术前TPS制定治疗计划,术后质量验证.肿瘤处方剂量110～120Gy,质量验证D90＞100Gy,V90＞93%,如剂量不足,重新补种粒子或外照射.结果植入病例全部成功,无死亡,1年后局控率达83.92%.术后有16例咯少量血痰,51例中心型肺癌患者中有11例出现气胸,44例周围性肺癌患者中有6例出现气胸;7例胸腔闭式引流,10例经过胸穿排气处理后自然缓解.胸痛缓解100%(32/32),胸闷、气短缓解83.33%(70/84),阻塞性肺炎治愈95.24%(40/42),咯血治愈91.43%(32/35),上腔静脉梗阻好转100%(18/18).治疗期间未出现胸腔出血、放射肺炎症状,未发现粒子脱落或游走等并发症.结论CT引导下经皮穿刺植入125I粒子组织间近距离治疗NSCLC安全、有效,且创伤小、并发症少.     

CT引导下经皮肺穿刺活检的临床应用

目的:对CT引导下经皮肺穿刺术的临床应用进行评估.方法:CT引导定位下用9～12号腰穿针和Bard穿刺枪对120例患者进行穿刺活检.结果:120例肺穿刺患者中有84例肺癌(70%)经组织或(和)细胞学检查得到诊断,其中细胞学检查阳性者61例(72.6%),组织学检查阳性者68例(80.9%).穿刺敏感性为93.3%,特异性为100%,诊断准确性为97.5%.并发症8例(6.7%),其中气胸5例,痰血3例.结论:CT引导下经皮肺穿刺准确性高,并发症少,安全可靠,可为临床提供诊断依据,值得推广.