阴囊Paget病的诊疗分析（附28例报告并文献复习）

目的：探讨阴囊Paget病的临床特点,提高对其诊断、治疗及预后的认识。方法：回顾性分析我院28例阴囊Paget病的诊治资料,复习相关文献,并进行随访。28例患者术前均经病理活检证实为阴囊Paget病。Ray分期标准,A,期15例,A：期8例,B期5例。手术治疗27例,其中21例行根治性病灶切除术,6例因病灶较大行病灶扩大切除及股部带蒂皮瓣修补术,5例经病理证实腹股沟淋巴结有转移者行单侧或双侧腹股沟淋巴结清扫术。放疗、化疗1例。结果：术后均经病理学检查确诊。术后26例获随访,随访3个月-15年,平均4年。2例分别于术后5个月、1年局部复发,均再次手术治愈。1例术后2年死于多发骨转移。其余无局部复发及转移。结论：阴囊Paget病是一种易发于老年男性的少见恶性肿瘤,极易误诊为阴囊湿疹、皮炎等疾病,确诊需依靠病理检查;治疗以病灶根治切除术为首选方法,早期治疗预后较好。     

阴囊Paget病9例临床资料分析

目的探讨阴囊Paget病的诊断及治疗。方法回顾9例阴囊Paget病患者临床资料，全部患者均在术前病理证实为阴囊Paget病，采用病灶广泛切除术治疗。结果A1期4例，A2期3例，B期2例。7例获得随访，随访时间为6个月—5年。2例淋巴结转移者，分别于术后1年与2年死于广泛转移；1例术后2年复发而行二次手术治疗；其余无复发。结论对经久不愈的阴囊皮损应尽早行活检确诊，病灶广泛切除术是治疗本病的有效手段。     

阴囊Paget病5例报告

目的：探讨阴囊Paget病的临床特点及诊治方法。方法：对5例阴囊Paget病的临床资料进行回顾性分析。结果：所有病例均经病理诊断证实，在抗感染治疗的基础上，均行病灶扩大切除术，1例腹股沟淋巴结转移者同时行清扫术，该病例于术后2a死于全身转移，其余病例健在。结论：对久治不愈的阴囊皮炎、湿疹应行病灶活组织检查，确诊患者应行病灶扩大切除术。     

阴囊Paget病79例报告

目的 探讨阴囊Paget病的临床特征、治疗原则和预后因素。方法 回顾性分析我院1993年至2004年收治的经病理证实为阴囊Paget病患者的临床资料。79例患者平均年龄62．3岁,平均病程3年7个月。除1例采用激光治疗外,其余78例均采用局部扩大切除术。7例腹股沟区淋巴结转移者行髂腹股沟淋巴结清扫术。结果 术后局部复发9例,与本病相关死亡3例。结论 阴囊Paget病术后预后良好,治疗的关键是对该病提高警惕,并及早进行组织学检查。     

阴囊Paget病合并汗腺癌6例报道及临床分析

背景与目的：阴囊Paget病合并汗腺癌极为少见,本文总结阴囊Paget病合并汗腺癌的临床病理特点及其治疗情况。方法：回顾性分析1964—2004年我院收治的阴囊Paget病合并汗腺癌患者6例,复习文献并分析其典型表现、诊断及治疗方法。结果：阴囊Paget病合并汗腺癌典型表现以湿疹样皮肤改变为主。本组所有患者接受病灶切除并患侧腹股沟淋巴结清扫术,1例行腹直肌带蒂皮瓣转移术。术后15、26、38月各死亡1例,3例术后随访48,50,55个月,未见复发。结论：病灶手术切除及患侧腹股沟淋巴清扫是治疗阴囊Paget病合并汗腺癌的主要方法。     

乳房外Paget病8例临床分析

目的 探讨乳房外Paget病的组织发生、诊断治疗以及预后。方法 回顾性复习8例乳房外Paget病的病例、病理资料和随访资料。结果 7例病灶发生于阴囊和大小阴唇；从症状出现到确诊时间平均2．95年；所有病人均行局部皮肤扩大切除术，其中2例切缘阳性，均局部复发而二次手术；3例行腹股沟淋巴结清扫，发现2例转移；平均随访2．3年，均生存。结论 提高早期诊断率，降低误诊漏诊率，及时行扩大的病灶切除手术是提高病人生存率的关键。     

46例阴茎癌的临床分析及总结——附文献复习

背景与目的:阴茎癌是一种少见的疾病,以鳞状细胞癌为主,主要通过淋巴途径转移.治疗包括局部原发癌切除和对转移淋巴结的处理及放疗、化疗等辅助治疗.本研究旨在探讨阴茎癌合理的治疗方法.方法:对中山大学附属第一医院1996年1月至2005年1月收治的46例阴茎癌患者的临床资料进行回顾性分析,46例患者中鳞状细胞癌44例,Paget病1例,疣状癌1例,对其中23例肿大淋巴结进行活检.结果:39例行阴茎部分切除术,4例行阴茎全切加会阴部尿道造口术治疗,1例Paget病患者行病灶切除植皮术,2例未接受手术治疗.10例淋巴结活检阳性的患者中有9例行腹股沟淋巴结清扫术,5例行同期盆腔淋巴结清扫术.41例患者获定期随访1～10年,1年、2年、5年、10年生存率分别为95.1%、95.1%、82.9%、31.7%.术后病理证实有盆腔淋巴结转移者2例均在2年内死于肺转移.结论:阴茎部分切除术是治疗阴茎癌合理有效的方法,且应尽早手术治疗.淋巴结转移是影响阴茎癌预后的重要因素,有腹股沟淋巴结转移者应早期行淋巴结清扫术治疗,以提高治疗效果.有盆腔淋巴结转移者预后差.     

阴囊Paget病的临床和病理研究

目的：探讨阴囊Paget病的临床特点和诊治方法。方法：对14例阴囊Paget病患者的临床、病理资料以及治疗和随访情况进行回顾性研究。结果：14例患者经病理检查证实并行手术治疗，随访2－12年，1例腹股沟淋巴结阳性者1例后死于全身转换，3例死于非癌疾病，3例行腹股沟淋巴结清扫者2例发和皮肤坏死、淋巴瘘等并发症。结论：本病的诊断主要依靠病理学检查，阴囊局部扩大切除是首选治疗方法。预后主要取决于病变浸润的程度，淋巴结有无转换以及是否伴有邻近内脏器官的恶性肿瘤，早期诊断是提高生存率的关键。     

阴囊Ｐａｇｅｔ病１５例临床分析

目的：探讨有关阴囊Ｐａｇｅｔ病的临床特点、治疗方法和预后。方法：对１５例阴囊Ｐａｇｅｔ病患者的临床资料进行回顾性研究,全部患者先行患处活检,后手术治疗。结果：所有患者术后病理检查均发现Ｐａｇｅｔ细胞。根据Ｒａｙ分期：Ａ１期１０例,Ａ２期３例,Ｂ期２例（９例肿瘤局限于表皮,６例侵及真皮）。７例淋巴结肿大者经病理活检证实２例为淋巴结转移。１２例获得随访,随访时间３个月～５年,均未复发。结论：阴囊Ｐａｇｅｔ病应尽早活检确诊,病变局部广泛切除是本病首选治疗方法,愈后较好。     

阴囊Paget病的诊断与治疗(附15例报告)

探讨阴囊Paget病的诊断与治疗。方法　术前活检明确诊断。术中行阴囊皮肤局部扩大切除术 ,同时行双侧腹股沟淋巴结活检。对于明确有淋巴结转移者 ,均行盆腔放疗 ;对于无转移者 ,口服环磷酰胺化疗。结果　 15例中 ,14例获得随访 ,2例腹股沟转移者于术后 14个月和 16个月死于全身转移 ,3例死于非肿瘤疾病 ,其余病例均无复发。结论　对于久治不愈的阴囊皮肤湿疹 ,应及时活检以明确诊断 ,诊断明确后应及时手术治疗 ,对于转移者加用放疗 ,无转移者口服化疗。     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.