胆囊切除术前的选择性胃镜检查

目的:探讨胆囊切除术前的选择性胃镜检查的必要性.方法:回顾分析287例慢性结石性胆囊炎拟住院行胆囊切除术,术前因合并消化不良症状而接受胃镜检查的病例资料,并根据消化不良症状轻重及年龄(＜40岁组及≥40组岁)分别分为两组,统计胃癌检出率,比较差异.结果:检出早期胃癌2例,进展期胃癌4例,胃及十二指肠溃疡21例,胃黏膜相关性淋巴瘤1例.根据消化不良症状轻重分组两组胃癌检出率分别为1.78%(3/169)和2.54%(3/118),P＞0.05,差异无显著性.根据年龄分组两组胃癌检出率分别为0(0/140)和4.08%(6/147),P＜0.05,差异有显著性.结论:40岁以上胆囊结石患者,只要合并存在消化不良症状,术前应该行胃镜检查.     

残胃状态下食管癌与贲门癌的外科治疗策略

目的：探讨残胃状态下食管癌及贲门癌的外科治疗策略。方法：本院自2005年1月-2012年12月共收治残胃状态下食管癌及贲门癌患者8例,均行外科根治性手术治疗。结果：本组8例确诊患者的残胃状态时间平均为11.7年,其中BillrothI式吻合术者2例;BillrothII式吻合术者6例;2例食管癌患者行三切口食管癌切除联合结肠代食管术,6例贲门癌患者均经腹部手术切口,2例行贲门癌下段食管切除联合间置空肠代食管吻合术,4例行贲门癌残胃全切除联合P形空肠袢代胃Roux-en-Y式吻合术。结论：对于胃大部切除后残胃状态下的患者,早期或局部晚期的食管癌与贲门癌亦可行根治性手术,手术前需根据患者病变情况,选择合适的个体化手术方案,同样可以达到理想的治疗效果。     

P16、CD44v6和TGF-β1在胃癌中的表达及其相关性研究

目的 探讨多肿瘤抑制基因（P16）、细胞黏附分子变异体（CD44v6）和转化生长因子-β1（TGF-β1）在胃癌中的表达及其相关性.方法 采用免疫组化方法（SP法）检测78例胃癌组织、20例胃黏膜非典型增生和25例正常胃黏膜组织中P16、CD44v6和TGF-β1的表达情况,并结合临床病理因素进行分析.结果 P16在胃癌组织（46.2%）和胃黏膜非典型增生（60.0%）中的表达明显低于其在正常胃黏膜组（92.0%）表达;CD44v6在胃癌组织（51.3%）和胃黏膜非典型增生（45.0%）中的表达明显高于其在正常胃黏膜组（4.0%）表达;TGF-βl在胃癌组织中的表达（65.4%）明显高于其在正常胃黏膜组（12.0%）和胃黏膜非典型增生组（35.0%）表达.P16表达与胃癌分化程度、浸润深度,淋巴结转移和TNM分期有关（P〈0.05）,而与胃癌肿瘤大小、脉管瘤栓和进展情况无关（P〉0.05）;CD44v6表达与胃癌浸润深度、淋巴结转移、进展情况和TNM分期呈有关（P〈0.05）,而与组织分化程度、肿瘤大小和脉管瘤栓无关（P〉0.05）;TGF-β1表达与胃癌组织分化程度、浸润深度、淋巴结转移和TNM分期有关（P〈0.05）,而与肿瘤大小、脉管瘤栓和进展情况无关（P〉0.05）.胃癌组织中CD44v6及TGF-β1的表达呈正相关（r=0.532,P〈0.05）;CD44v6及P16的表达呈负相关（r=-0.615,P〈0.05）.结论 P16、CD44v6和TGF-β1在胃癌的发生发展中起着不同程度的作用,联合检测P16、CS44v6和TGF-β1可能有助于判断胃癌的恶性程度、转移潜能及预后分析.     

双介入法治疗胃窦癌术后残端复发

目的探讨双介入法治疗胃窦癌胃大部切除术后残端复发的疗效及临床价值。方法11例远端胃癌胃大部切除术后残端复发并狭窄患者，其中2例伴腹水，3例肝转移。均行内支架及腹腔动脉化疗，2例腹水者首次行腹腔化疗，肝转移者行碘油栓塞。根据病人情况重复腹腔动脉化疗。所有病例均获随访。结果6个月生存率63．6％，12个月生存率45％，18个月生存率18％。平均生存期12个月。结论动脉化疗并支架植入治疗残胃癌，可以延长患者的生存期，提高生存质量。     

Infectious agents and gastric tumours. An increasing role for Epstein-Barr virus

Helicobacter pylori (H. pylori) and Epstein-Barr virus (EBV) are 2 common and widely disseminated agents throughout the world. H. pylori has been classified, by the International Agency for Research on Cancer conference, as a class I carcinogen, i.e. undoubted cause of gastric cancer. However, this infection does not explain all the epidemiological and histological variations of the malignancies affecting the stomach. EBV has been identified, in the last decade, in the tumour cells of patients with gastric carcinoma and recent findings suggest the possibility of distinct mechanisms in its pathogenesis. A prevalent role of the virus has been described in a subset of stomach cancers, namely lymphoepithelioma-like carcinomas. The present update attempts to focus on the epidemiological evidence and the biological plausibility for a causal role of H.pylori and EBV infection in the pathogenesis of gastric cancer.     

Early gastric cancer--two case reports

Gastric cancer is a serious disease with a high mortality rate. Early diagnosis of the disease improves its prognosis. We report two cases of early gastric cancer and we specify the clinical, endoscopic, histologic and therapeutic aspects of the disease. This study is about two female patients, respectively, 36 and 70 years old. The diagnosis of early gastric cancer was based on pathologic examination of the resected stomach. The two patients are in remission 2 years and 6 months later, respectively. The diagnosis of early gastric cancer is often made on nonspecific symptoms. Oeso-gastro-duodenoscopy shows gastric mucosal anomalies. Pathologic examination of gastric biopsies confirm the diagnosis of adenocarcinoma. Endoscopic ultrasound is essential; it specifies the submucosal infiltration and evaluates the lymph node invasion. Surgery is the primary treatment but in some cases endoscopic mucosal resection provides good long-term results. Early diagnosis of adenocarcinoma improves the prognosis of the disease, which remains poor nowadays.     

胃癌患者血清甲胎蛋白表达的临床意义

目的探讨胃癌患者血清甲胎蛋白表达的临床意义。方法对187例胃癌患者进行回顾性分析,比较甲胎蛋白阴性和阳性2组胃癌患者的生物学特征（浸润深度、肝脏转移、淋巴结转移程度、临床分期）,生存率及预后因素。结果肝脏转移、多个淋巴结转移发生率,AFP阳性组均明显高于AFP阴性组（P〈0.01）。AFP阳性组l、3、5年生存率为57.1%、8.9%和近0,明显低于AFP阴性组的90.3%、62.7%、49.8%（P〈0.01）,AFP表达为胃癌的独立预后不良因素,与患者的生存期呈负相关（P〈0.01）。结论胃癌患者AFP高表达提示其易发生肝脏和淋巴结转移,且预后不良。     

Epstein-Barr virus genome positive lymphoepithelioma-like carcinoma of the stomach]

EBV is associated with a high number of tumours and non-tumourous conditions. The rare lymphoepithelioma like carcinoma of the stomach,--just as similar tumours of foregut origin (thymus, lung, salivary gland)--are frequently EBV genom positive with the expression of only a few genes (EBV nuclear antigen 1, EBV encoded ribonucleoproteins/EBER/, latency I). On the basis of the clinicopathological analysis of two cases and literature data the authors point out the male predominance and the relatively favourable prognosis of the patients, furthermore the frequent cardial-subcardial localization of these tumours. Since the frequent non-lymphoepithelioma like stomach tumours,--adenocarcinomas,--show EBV genom positivity in about 1% of the cases, it is concluded that the characteristic lymphoepithelioma like histological pattern is not a sine qua non condition of EBV genom positivity. It may also be assumed, that the CD8 and TIA 1 cytotoxic lymphocytes are not virus but tumour cell specific, however not efficient, perhaps not activated. The low level of apoptotic tumour cells supports this assumption. In one of the cases a double tumour, a genom positive lymphoepithelioma like carcinoma and a genom negative adenocarcinoma, adjacent to each other was seen which speaks in favour of common carcinogenetic factors and shows that microscopic neighbourhood is not a necessary condition in viral association. The origin of the possible oncogenic effect of EBV in the absence of the transforming gene products latent membrane protein 1 and EBNA 2 in genom positive stomach carcinomas is uncertain. The significance of the presence in both cases of CD 5+ tumour cells is not clear, the study of further cases is indicated.     

CD44v6和P16蛋白表达与胃癌浸润和转移的关系

目的探讨CD44v6和P16蛋白表达与胃癌浸润、转移的相关性。方法应用免疫组化CSA法检测110例胃癌组织中CD44v6和P16蛋白表达。结果110例胃癌中CD44v6和P16蛋白阳性表达分别为72.7%(80/110)和47.3%(52/110)。CD44v6蛋白高表达及P16蛋白低表达与胃癌TNM分期、浆膜浸润、淋巴结转移和肝脏转移均呈正相关关系(P<0.05)。胃癌中CD44v6表达与P16表达呈负相关(r=-0.589,P<0.05)。结论CD44v6和P16蛋白表达与胃癌浸润、转移密切相关。检测二者基因表达产物均可作为预测胃癌浸润、转移的客观指标。     

胃癌手术患者预后影响因素分析

目的探讨胃癌患者术后生存的影响因素。方法应用单因素和多因素Cox回归分析方法,回顾性分析2000年1月-2005年12月有完整临床资料和随访资料的289例胃癌患者临床资料。结果 289例胃癌患者术后1年、3年和5年生存率分别为80.96%、50.87%和42.91%;单因素分析表明：肿瘤浸润深度、淋巴结转移、远处转移、Bor-rmann分型、肿瘤部位、组织病理学分级、TNM分期和肿瘤的根治度、化疗疗程对胃癌患者的5年生存率均有影响（P〈0.05）。Cox回归分析显示：Borrmann分型、病理组织学分级、肿瘤浸润深度、淋巴结及远处转移,TNM分期和化疗6个疗程7个因素是影响胃癌术后生存的独立因素（P〈0.05）。结论胃癌的Borrmann分型、病理组织学分级、肿瘤浸润深度、淋巴结转移、远处转移、TNM分期和化疗6个疗程是影响其术后生存的重要因素。     

乳腺癌患者癌组织中EB病毒感染基因产物的研究

目的:调查乳腺癌患者癌组织中EB病毒(Epste in-Barr virus,EBV)感染状况,分析EBV感染基因产物的表达。方法:原位杂交法检测180例乳腺癌患者癌组织及相应癌旁组织石蜡标本中EBV编码的小RNA(EBER1);免疫组化法检测EBV潜伏感染膜蛋白1(LMP1)。结果:180例乳腺癌患者癌组织标本中检测到17例EBER1表达,阳性率为9.4%;而相应癌旁组织中均未检测到EBV感染,二者差异有统计学意义(χ2=17.84,P<0.05)。乳腺癌组织中均未检测到LMP1的表达。结论:部分乳腺癌的发生与EBV感染有一定的相关性,乳腺癌中可能缺乏LMP1的表达。     

Epstein-Barr virus and multiple sclerosis

It has been suggested that the Epstein-Barr virus (EBV) plays a role in the etiology of multiple sclerosis (MS), but individual epidemiologic studies have been inconclusive, in part because of the high prevalence of previous infection among individuals without MS. We conducted a systematic review of case-control studies comparing EBV serology in MS patients and controls. Eight published investigations were identified, including a total of 1,005 cases and 1,060 controls. The summary odds ratio of MS comparing EBV seropositive individuals with EBV seronegative individuals was 13.5 (95% CI = 6.3-31.4). The strength and consistency of this association and the high sensitivity and specificity of EBV serology suggest that these results are not readily explained by an aspecific immune activation among MS patients. These findings support a role of EBV in the etiology of MS.     

慢性阻塞性肺疾病肺间质性纤维化CT改变与肺功能分级的对比研究

目的 探讨慢性阻塞性肺疾病肺间质性纤维化的CT改变与肺功能分级的对比情况.方法 按照患者的肺功能进行分级,再对患者应用CT进行检查,观察各组患者的影像学改变.结果 在肺功能的各个分级中,小叶间隔增厚、支气管血管束增粗、肺内异常线影发生率较高.结论 慢性阻塞性肺疾病肺间质性纤维化患者在疾病的早期已经有影像学上的改变,可以作为疾病诊断的依据,并且以小叶间隔增厚、支气管血管束增粗、肺内异常线影发生率较高,在临床的疾病诊断过程中值得重视并广泛应用.     

Helicobacter treatment with quadruple therapy in primary health care for patients with a history of ulcer disease.

BACKGROUND: Few patients with a history of peptic ulcer are treated by their GP for H. pylori infection, even though theoretical evidence supports such an approach. OBJECTIVES: We aimed to determine the validity of this recommendation and to test the feasibility of quadruple therapy in primary health care. METHODS: In this prospective, non-randomized intervention study, 51 unselected patients with a history of proven ulcer disease received a 7-day quadruple therapy (lansoprazole, colloidal bismuth subcitrate, tetracycline and metronidazole) from their GP. Main outcome measures were: (i) endoscopically confirmed cure of the infection; (ii) results of serology at entry and at 6 months follow-up; (iii) quality of life at entry, at 6 weeks and at 6 months follow-up; (iv) gastric symptoms at entry, at 6 weeks and at 6 months follow-up; and (v) medication at entry and at 6 months follow-up. RESULTS: Quadruple therapy was well tolerated and there were no drop-outs with this regimen. Intention to treat cure rate was 48/51 (94%, 95% CI 87-100%), per protocol cure rate was 48/49 (98%, 95% CI 94-100%). 45/50 (90%) had positive serology at entry. IgG antibody titres decreased > 40% in 95.2% of patients. Quality of life improved significantly after treatment, gastric symptoms decreased and medication use decreased. CONCLUSIONS: GPs should be encouraged to identify patients with a history of ulcer disease and chronic use of acid suppressants and offer them treatment for H. pylori infection. This approach will cure the infection in almost all patients, it will improve the quality of life and decrease costs. Quadruple therapy does not lose efficacy when employed in primary care. Pre-treatment serological testing is potentially useful for narrowing down the treatment group to those with actual infection, and serology is promising as an easy and cheap follow-up instrument in primary health care.     

Epidemiological characteristics of adenocarcinoma of the gastric cardia and distal stomach in the United States, 1973-1982

Data from the Surveillance, Epidemiology, and End Results (SEER) programme of the National Cancer Institute were utilized to estimate the incidence of adenocarcinoma of the gastric cardia and distal stomach in the US in order to determine whether the epidemiological features of these diseases differ. Based upon 12,562 histologically confirmed cases identified, the annual incidence of gastric cardia adenocarcinoma was 1.1 per 100,000 people and for the distal stomach 3.8 per 100,000. The male-to-female ratio for adenocarcinoma arising in the cardia was 7.0, versus 2.2 for that arising in the distal stomach. The sex ratio shifted across age groups for the gastric cardia and was highest for the 50-59 year age group, but remained relatively stable across age groups for cancers of the distal stomach. Over the decade studied, the sex ratio decreased from 8.0 to 4.6 for gastric cardia tumours, but remained constant for adenocarcinoma of the distal stomach. Blacks were 2.5 times more likely to develop adenocarcinoma of the distal stomach than whites, but had a 50% lower risk of gastric cardia tumours than whites. These results support an emerging concept that adenocarcinoma of the gastric cardia, gastro-oesophageal junction and distal oesophagus may comprise a group of disease which is aetiologically distinct from distal gastric tumours.     

Gastric adenocarcinoma secondary to Hodgkin's disease treatment

Second malignant neoplasms are a major cause of late morbidity and mortality following treatment for Hodgkin's disease. Gastric carcinoma belong to the rare secondary malignancies induced by radiation-therapy and it is associated with a poor prognosis. We report a patient treated for Hodgkin's disease by 6 ABVD and total lymphoid radiation therapy, who developed a gastric carcinoma 9 years after completing treatment. Our case fits the criteria for radiation induced malignancies reported from the literature: In conclusion: recommendations are presented for both prevention and early detection of the tumours we recommend a strict follow-up for patients treated for HD to detect second cancers.     

血管内皮生长因子-C在胃癌中的表达及临床意义

目的探讨血管内皮生长因子-C(VEGF-C)在胃癌中的表达及临床意义。方法收集潍坊市妇幼保健院、潍坊市人民医院2008年1月—2011年1月手术切除的80例胃癌原发病灶,均有完整的临床资料,术前都未经放疗、化疗。正常胃部组织26例。采用免疫组化PV-6000法检测VEGF-C在80例胃癌术后病理标本和26例正常组织中的表达。结果 VEGF-C的阳性表达主要为胞浆着色。VEGF-C在胃癌中的表达高于在正常胃部组织中的表达,差异有显著性(P<0.05),VEGF-C的阳性表达与胃癌患者的性别、年龄、肿瘤的大小、分化无明显相关性(P﹥0.05),VEGF-C的阳性表达随肿瘤浸润深度的增加而增加(P<0.05),随淋巴结的转移而增加(P<0.05),临床分化较晚,阳性率较高(P<0.05)。结论 VEGF-C和胃癌的浸润和转移密切相关。     

Fish方法检测HER2基因在胃癌组织中的表达及其意义

目的探讨胃癌组织中HER2基因表达与临床病理特征的相关性。方法采用荧光原位杂交(Fish)技术,检测43例胃癌石蜡组织中的HER2基因扩增状况,将检测结果与患者的临床病理特征进行相关性分析。结果 43例病例中,15例(34.88%)患者胃癌组织中有HER2基因表达,且与TNM分期、淋巴结转移及胃癌浸润深度相关(P值均<0.05)。结论 HER2表达在胃癌中发生率较高,可作为评价胃癌生物学行为及预后的指标。     

Pronostic factors in squamous cell carcinoma of the vulva. About 35 cases

OBJECTIVE: To evaluate the pronostic factors of the vulvar cancer. STUDY DESIGN: This is a retrospective study, of 35 cases of squamous cell carcinoma of the vulva diagnosed and treated at Farhat Hached Hospital (Sousse) between January 1991 and December 2002. The study of the pronostic factors is based on analysis of the following parameters obtained after a period varyinf from 6 months to 5 years: clinical data, pre-therapeutique and therapeutic evaluation, pathologic data, outcome and survival rate. RESULTS: The diagnostic was often late with a delay for consultation superior to 6 months in 60% of cases. 80% of the patient wete in stages III and IV of FIGO with an average tumorous size of 3.8 cm and palpable lymph node in 74.2% of the cases. 22 patient underwent vulvectomy with bilateral inguinal node dissection. Adjuvant therapy was carried out in 8 cases. The rate of relapses was 22.7%. The global survival at 5 years of the operated patients was of 40%. The main prognostic factors were: the size tumorale, the degrees of stromal invasion and the lymph node invasion. CONCLUSION: Early detection fo vulvar concer by regular gynecologic examinations and a biopsy of all suspect lesions, allows an early treatment consequently a better prognosis.