放射性肠炎的发病相关因素及预防研究进展

随着放疗技术在肿瘤治疗中的不断应用,放射性肠炎的发病率逐年增加,临床上有关放射性肠炎防治的文献报道也越来越多.临床针对放射性肠炎的高危人群,采取物理策略的预防、维持良好的膀胱容量、改进放疗技术以及药物预防来减少放射性肠炎的发生.本文就放射性肠炎诱发及加重因素和预防措施做一简要总结.     

经静脉应用小牛血去蛋白提取物并西药保留灌肠治疗宫颈癌急性放射性肠炎的疗效

目的:总结静脉应用小牛血去蛋白提取物辅以西药保留灌肠治疗宫颈癌放疗引起的急性放射性肠炎的疗效.方法:对30例宫颈癌放疗引起的急性放射性肠炎患者静脉应用小牛血去蛋白提取物1周以上,部分患者辅以多种西药混合保留灌肠.结果:总治愈率96.7％,总有效率100％.结论:静脉应用小牛血去蛋白提取物治疗急性放射性肠炎疗效确切,部分患者需辅以西药保留灌肠.     

预防性护理对前列腺癌患者放疗中放射性肠炎及生存质量的影响

目的 探究预防性护理对前列腺癌患者放疗中放射性肠炎及生存质量的影响。方法 选取2017年2月至2019年2月在我院进行放射治疗的78例患者,将患者随机分为常规组及干预组,对常规组患者行常规护理干预,对干预组患者在常规护理干预基础上,行预防性护理干预,比较两组患者放射性肠炎发生几率,干预前后生存质量。结果 干预组患者放射性肠炎发生几率为12.82%,显著优于常规组的48.72%（P＜0.05）;在干预前,两组患者免疫功能及生活质量均无显著差异（P＞0.05）,干预后,干预组患者生活质量评分为（62.47±4.59）分,显著高于常规组的（48.16±5.17）分（P＜0.05）。结论 在前列腺癌患者放疗过程中对其进行预防性护理,能够有效降低放射性肠炎发生几率,同时对提高患者生存质量具有重要意义,值得推广。。     

Primary extranodal malignant lymphoma

Primary extranodal lymphoma with high frequency and/or unique feature in Japan is discussed. Waldeyer ring lymphoma is most frequent(30%). Most tumors consist of diffuse, large cell type of B cell. CHOP followed by radiation achieved 94.1% of 5 years survival. Gastrointestinal lymphoma is another frequent lymphoma. Surgical rejection followed by chemotherapy and radiation therapy achieved high response. Pyothorax-associated lymphoma is a unique entity reported in Japan. EB-virus and artificial pneumothorax are related to its occurrence. In intravascular lymphomas, lymphoma cells regionally exist in small vessel and are diffuse, large cell type of B cells. Brain is frequently involved. Bone lymphoma is found in 4-8%. The prognosis depend on the site and 5 year relapse-free survival is 70%.     

A case of mucosa-associated lymphoid tissue lymphoma of the gastrointestinal tract showing extensive plasma cell differentiation with prominent Russell bodies

A 73-year-old Japanese woman was hospitalized for detailed examination of nausea, diarrhea and loss of appetite. Atypical erosion in the ileum was found on endoscopy. Biopsy of this erosion showed proliferation of cells containing numerous Russell bodies. Differential diagnoses considered were Russell body enteritis, crystal-storing histiocytosis, Mott cell tumor, immunoproliferative small intestinal disease (IPSID) and mucosa-associated lymphoid tissue (MALT) lymphoma. The cells containing prominent Russell bodies showed diffuse positivity for CD79a and CD138, but negative results for CD20, CD3, UCHL-1, CD38 and CD68. Russell bodies were diffusely positive for lambda light chain, but negative for kappa light chain, and immunoglobulin (Ig) G, IgA and IgM. Based on these findings, Russell body enteritis, crystal-storing histiocytosis and IPSID were ruled out. As the tumor formed no mass lesions and was restricted to the gastrointestinal tract, MALT lymphoma with extensive plasma cell differentiation was finally diagnosed. The patient showed an unexpectedly aggressive clinical course. The number of atypical lymphocytes in peripheral blood gradually increased and T-prolymphocytic leukemia (T-PLL) emerged. The patient died of T-PLL 7 mo after admission. Autopsy was not permitted.     

MRI Manifestations of gastrointestinal wall thickening

The appearance of gastrointestinal wall thickening of various entities is demonstrated on magnetic resonance imaging (MRI). The entities include benign gastric ulcer, gastric carcinoma, pancreatic carcinoma with direct invasion of stomach, duodenal leiomyoma, radiation enteritis, peritonitis, colonic carcinoma, recurrent carcinoma at the gastrojejunal anastomosis with direct extension to the transverse colon, colocolic intussusception, sigmoid diverticulitis with pericolonic abscess and fistula into the urinary bladder, and lymphoma of the stomach, duodenum, small bowel, and colon. Air was introduced antegradedly or retrogradedly into the alimentary tract to act as a contrast agent. When the bowel was distended by air, the normal bowel wall was barely visible or even invisible. Abnormal focal or segmental wall thickening was outlined between the intraluminal air and extraluminal fat. In some instances, the thickenings were better demonstrated on coronal or sagittal sections. The proper muscular layer of the bowel has a low-signal intensity and was delineated between the thickened mucosa—submucosa and extramural fat. Interruption of this low-intensity zone might represent tumor invasion through the muscular layer.An invited commentary on this article follows on pp. 403–404.     

Clinical significance of prostaglandins in the gastrointestinal tract

Endogenous prostaglandins are involved in several gastrointestinal diseases such as peptic ulcer. Crohn's disease, ulcerative colitis and radiation enteritis, although a casual role has not been proven in any condition. At present therapeutic indications are confined to the treatment of peptic ulcer with synthetic analogues at a dosage which inhibits acid secretion.     

不同体位对妇科肿瘤调强放射治疗剂量学和急性放射性肠炎的影响

目的 探讨妇科肿瘤调强放射治疗（IMRT）采用俯卧位或仰卧位对危及器官剂量学及放射治疗不良反应的影响,优化IMRT体位固定方式。方法 选择42例宫颈癌及子宫内膜癌IMRT患者,按体位固定方式分为俯卧组23例与仰卧组19例。在相同条件下勾画靶区和危及器官并进行治疗计划优化,比较2组患者危及器官剂量-体积关系,分析2组患者急性放射性肠炎的发生情况。 结果 俯卧组小肠接受15~50 Gy照射剂量的体积均小于仰卧组,其中2组接受20、30、40 Gy剂量的体积比较差异均有统计学意义（P均< 0.05）。俯卧组患者结肠接受30、40、45 Gy剂量的体积比较差异均有统计学意义（P均< 0.05）。俯卧组膀胱接受15~50 Gy照射剂量的体积比仰卧组稍升高,但仅接受20 Gy照射剂量的体积在组间比较差异有统计学意义（P < 0.05）。2组患者直肠及股骨头的剂量-体积关系比较差异无统计学意义（P > 0.05）。俯卧组患者消化不良、恶心、呕吐、腹痛和腹泻等急性放射性肠炎的发生率低于仰卧组,但组间比较差异无统计学意义（P均> 0.05）。 结论 妇科肿瘤IMRT采用俯卧位可降低小肠及结肠接受照射剂量。     

Case series on patients with primary central nervous system lymphoma: From clinical presentations to outcomes

Primary central nervous system lymphoma (PCNSL) is a rare form of non‐Hodgkin lymphoma. In this report, we present 11 cases of PCNSL which were treated with high‐dose MTX and WBI with a localized radiation boost to the tumor bed.     

儿童骨原发性非霍奇金淋巴瘤3例临床病理分析及文献复习

目的探讨儿童骨原发性淋巴瘤的临床病理学特征，评估免疫组化染色在鉴别诊断中的意义。方法对3例儿童骨的恶性淋巴瘤，复习临床资料并进行病理学检查及免疫组化染色分析。结果3例均诊断为骨原发性非霍奇金淋巴瘤，B细胞来源，其中1例为B淋巴母细胞型，1例为弥漫大B细胞型，1例不能确定类型。3例均行病变部位的肿瘤切除术，术后化疗。结论儿童骨原发性淋巴瘤是一种罕见的恶性肿瘤，临床及放射学上难与其他儿童骨恶性肿瘤鉴别，免疫组化染色在诊断中不可或缺。恰当的化疗方案对于患者的预后至关重要。     

Radiation therapy for malignant lymphoma

For the treatment of malignant lymphoma(ML), it is important to recognize its clinical features. Recently, the role of radiation therapy(RT) has been reconsidered in the treatment of ML because of the effectiveness of combined modality treatment (CMT) for early-stage aggressive non-Hodgkin's lymphoma(NHL). Recent data suggest that adjuvant radiotherapy to the bulky site in advanced-stage aggressive NHL may significantly improve the relapse-free survival and overall survival. On the other hand, in the treatment of early-stage Hodgkin's disease(HD), meta-analysis data showed no apparent survival benefit from CMT or extended RT compared with RT alone. So in the initial treatment of early-stage HD, RT alone with adequate field should be recommended. Low-grade mucosa-associated lymphoid tissue(MALT) lymphoma is considered to be an additional indication for the use of RT because it is very sensitive to radiation and potentially curable with RT.     

Malignant lymphoma of the thyroid

Primary malignant lymphoma of thyroid is frequently associated with Hashimoto's thyroiditis and it is usually non-Hodgkin type. Thyroid lymphoma is common in women and the mean age at onset is 60 years old. The main symptom is rapidly growing goiter. The majority of histopathologic types are extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, diffuse large B-cell lymphoma, and mixed type of above two. If the findings on ultrasonography and fine needle aspiration cytology are suspected thyroid lymphoma, histopathological diagnosis of tissue obtaining from open biopsy is necessary. The treatment for thyroid lymphoma consists of chemotherapy (CHOP), rituximab combined with CHOP, and radiation therapy. It is selected based on the histopathologic type and the extent of disease. The prognosis depends on the histopathologic type and the staging. It should be recognized that early diagnosis and correct treatment lead to favorable prognosis.     

Risk of breast cancer and breast cancer characteristics in women treated with supradiaphragmatic radiation for Hodgkin lymphoma: Mayo Clinic experience

OBJECTIVE: To evaluate the overall risk of breast cancer and breast cancer characteristics in women given supradiaphragmatic radiation therapy for Hodgkin lymphoma. PATIENTS AND METHODS: Medical records of 653 female patients who received supradiaphragmatic radiation therapy for Hodgkin lymphoma at the Mayo Clinic in Rochester, Minn, between 1950 and 1993 were abstracted, and follow-up questionnaires were mailed. In 4 patients, breast cancer was diagnosed before Hodgkin lymphoma was discovered. RESULTS: The median age of 649 patients at supradiaphragmatic radiation therapy was 31.8 years (range, 2.6-86.5 years). The median duration of follow-up was 8.7 years (range, < 1-47.9 years). In 30 patients, breast cancer developed (bilaterally in 4 patients) after supradiaphragmatic radiation therapy; the median interval was 19.9 years (range, 0.7-423 years). The median age at breast cancer diagnosis was 44.4 years (range, 27.5-70.8 years). The standardized morbidity ratio for breast cancer after supradiaphragmatic radiation therapy was 2.9 (95 % confidence interval [CI], 2.0-4.2) (P < .001). Breast cancer risk significantly increased 15 to 30 years after patients received supradiaphragmatic radiation therapy, and risk was inversely related to age at supradiaphragmatic radiation therapy until age 30 years. The standardized morbidity ratio for patients younger than 30 years at supradiaphragmatic radiation was 8.5 (95% CI, 53-13.1) vs 1.2 (95% CI, 0.5-2.2) for those aged 30 years or older (P < .001). Splenectomy increased breast cancer risk (P = .01). Breast cancer detection was by self-examination in 15 cancers, by mammography in 13, and by clinical examination in 4; in 2 cancers, the mode of detection was unknown. Modified radical mastectomy was used to treat breast cancer. CONCLUSION: The increased risk of breast cancer in survivors of Hodgkin lymphoma given supradiaphragmatic radiation therapy appears to be limited to patients who are younger than 30 years at radiation therapy or to those who have undergone splenectomy.     

(18)F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings in Mucosa-associated Lymphoid Tissue Lymphoma of the Larynx: a Case Report and Literature Review

Laryngeal mucosa-associated lymphoid tissue (MALT) lymphoma is rare, with only 25 cases reported in the literature. This report presents a case of laryngeal MALT lymphoma in a 35-year-old female with a 6-year history of progressively worsening hoarseness. MALT lymphoma was diagnosed based on biopsy and immunohistochemical analysis. The patient received two cycles of cyclophosphamide + epirubicin + vincristine + prednisone (CHOP) chemo therapy, which was ineffective. (18)F-fluoro deoxy glucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) showed (18)F-FDG accumulation in the larynx only and identified stage IE lymphoma. CHOP chemotherapy was terminated and the patient was treated with radiotherapy. After 3 months (total radiation dose 27 Gy), (18)F-FDG PET/CT scan showed that the laryngeal lesion was in complete remission. A review of the literature on the MEDLINE(?)/PubMed(?) databases regarding laryngeal MALT lymphoma and the use of PET/CT found that radiotherapy is the firstline treatment for stage I and II MALT lymphoma.     

异基因造血干细胞移植后的巨细胞病毒肠炎24例分析

目的 分析异基因造血干细胞移植(allo-HSCT)后巨细胞病毒(GMV)肠炎的临床特点、诊断方法和危险因素.方法 总结北京市道培医院2007年8月至2009年7月确诊的24例CMV肠炎患者的一般临床资料和内窥镜、组织病理学和病毒学检查结果,以及CMV肠炎与CMV病毒血症和移植物抗宿主病(GVHD)的关系.结果 87.5%的患者年龄≥18岁,诊断CMV肠炎的中位时间为allo-HSCT后第63天.内窥镜下的肠黏膜表现对区分单纯CMV肠炎和肠炎合并GVHD没有鉴别意义.用于诊断的方法包括组织病理学(32.1%)和病毒学(92.9%)检查.肠黏膜标本中每106个单个核细胞的CMV DNA定量大于105时更有诊断价值.在死亡和存活两组患者中进行了下列危险因素的比较:移植类型、预处理方案、更昔洛韦预防病毒天数、确诊肠炎前有无Ⅱ～Ⅳ度急性GVHD、GVHD确诊时间、是否使用≥1 mg/kg的甲泼尼龙治疗GVHD、GVHD距离确诊肠炎的时间、肠炎前是否有CMV血症、确诊肠炎的时间、肠黏膜CMV DNA定量,差异均无统计学意义.结论 进行内窥镜检查并通过组织病理学和病毒学检查确诊是CMV肠炎诊断中的决定性因素,最好进行全结肠检查并到达回肠末端.PCR方法能明显提高CMV检出率.对那些无法进行肠镜检查的患者,采用粪便检测CMVDNA能够对诊断提供帮助.

Abstract：

Objective To analyse the clinical features, diagnostic methods and risk factors of cytomegalovirus(CMV) enteritis after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Analysis was made on 24 cases of CMV enteritis after allo-HSCT in Beijing Daopei Hospital from Aug.2007 to Jul.2009, including clinical data, endoscopic diagnosis, histopathological and virological results, and the association between CMV enteritis with viremia and graft-versus-host disease(GVHD).Results 87.5% of the patients were over 18 years old.The median time to diagnosis of CMV enteritis was 63 days after HSCT.The mucosal lesions in enteroscopic examination had no significant differences between CMV enteritis and gastrointestinal GVHD complicated with the enteritis.The methods used in diagnosis included histopathology (32.1%) and virology (92.9%).The copies of CMVDNA in mucosal samples greater than 105/106 PBNC was better diagnosis.A number of risk factors were compared between the survival and death groups: type of transplant, conditioning regimen, the time span of ganciclovir prophylaxis therapy, grade Ⅱ - Ⅳ GVHD before enteritis, the time of diagnosis as GVHD, using MP≥1 mg,/kg to treat GVHD, the time between GVHD and enteritis, CMV viremia before enteritis, the time of diagnosis as enteritis, CMVDNA quantitation, and there were no any statistic differences.Conclusion Cytomegalovirus enteritis should be carefully diagnosed by histopathology and virology through endoscopic examination.It is better to undertake pan-colon endoscopy as well as terminal ileum examination for more accurate diagnosis.PCR can significantly improve the detection rate.CMVDNA detection in patients' stool may be helpful to diagnosis, especially for those patients who can not stand the endoscopy examination.     

Spinal cord compression secondary to metastatic non-Hodgkins lymphoma: a case report

Luo CC. Spinal cord compression secondary to metastatic non-Hodgkin’s lymphoma: a case report.Non-Hodgkin’s lymphoma spine metastasis is a rare entity. A woman in her mid fifties with history of non-Hodgkin’s lymphoma was admitted to the hospital with bilateral leg weakness, anesthesia, and incontinence. Magnetic resonance imaging of the spine showed diffuse metastatic disease involving the cervical, thoracic, lumbar, and sacral spine. She was treated with radiation therapy and high doses of corticosteroids. When discharged to home, she could ambulate with a rolling walker independently, was capable of self-catheterization, and could insert suppositories for a bladder and bowel program.     

轮状病毒肠炎患儿异型淋巴细胞和免疫球蛋白水平的变化分析

目的探讨轮状病毒（RV）肠炎患儿异型淋巴细胞数量及免疫球蛋白水平治疗前后变化的临床意义。方法分别检测50例RV肠炎患儿（肠炎患儿组）及30例健康小儿（健康对照组）治疗前后的血常规和异型淋巴细胞数量及血清免疫球蛋白水平。结果治疗前RV肠炎患儿组外周血异型淋巴细胞明显高于健康对照组（P〈0.01）,RV肠炎患儿血清免疫球蛋白IgA、IgM和IgG水平下降。治疗后RV肠炎患儿组外周血异型淋巴细胞低于治疗前（P〈0.05）,血清免疫球蛋白IgA、IgM和IgG水平上升甚至接近正常水平。结论 RV肠炎患儿治疗前后进行异型淋巴细胞数量及免疫球蛋白水平的检测有助于对病毒感染的判断及了解患儿的机体免疫功能状态和对疾病治疗的有效性,对RV肠炎患儿的治疗有指导意义。     

Urological complications of regional enteritis

Urological complications of regional enteritis occur frequently and may be clinically unsuspected. Radiographic findings include nephrolithiasis, characteristic stricture of the ureter, panvesiculitis, and enterovesical fistula. Less specific findings include renal amyloidosis and retroperitoneal abscesses. Mucosal nodularity of the bladder dome, even without gastrointestinal symptoms, should raise the possibility of regional enteritis. On the other hand, occult ureteral stenosis in patients with known regional enteritis may be present. For this reason, it is recommended that routine and periodic excretory urograms be a central part of the evaluation of the patient with regional enteritis.     

Development of monoclonal antibody therapy for malignant lymphoma

Lymphomas are among the tumors most responsive to chemotherapeutic agents and radiation therapy. Despite chemotherapeutic and radiological advances, tumor cell resistance still remains a problem, and the toxicity of chemotherapy and radiation therapy limits their potential. Less toxic therapies for lymphoma have been continued to search for effectiveness. Since the discovery of the hybridoma technology by Kohler and Milstein in 1975, utilizing antibodies as targeted therapy for lymphoma has been investigated for many years. After 20 years of clinical trials, monoclonal antibody therapy of lymphoma enters the new millennium ready for 'prime time'. Investigators' early enthusiasm was dampened by problems with tumor targeting, HAMA, and allergic reactions, but important advances in molecular biology and chelation chemistry have led to new and improved reagents. Rituximab(IDEC-C2B8) has already been approved by the FDA in USA and the Ministry of Welfare and Labour in Japan for relapsed CD20-positive lymphomas and indolent B-cell lymphoma including mantle cell lymphoma, respectively. Ibritumomab tiuxetan and iodine-131 anti-B1 antibody have an excellent anti-lymphoma profile, and both appear to have higher response rates than rituximab. Results from the rituximab vs. ibritumomab tiuxetan phase III trial clearly favor the latter especially in %CR. Radiolabeled Lym-1, T101, LL2, and anti-Tac data will be forthcoming. Continued refinements of immunotoxins will establish their possible therapeutic role, and a variety of antibody conjugates including drugs, prodrugs, nonprotein toxins, and other agents, will continue to be studied in the clinic. Bispecific antibodies for lymphoma are also in early clinical testing. Over the next 10 years, many of the major advances in lymphoma therapy will be antibody-based.     

An alpha slow-moving high-density-lipoprotein subfraction in serum of a patient with radiation enteritis and peritoneal carcinosis

An alpha slow-moving high-density-lipoprotein (HDL) subfraction was seen in a patient presenting with radiation enteritis and peritoneal carcinosis, who was given long-term cyclic parenteral nutrition. This subfraction, observed in addition to normal HDL, was precipitated with low-density lipoproteins (LDL) and very-low-density lipoproteins (VLDL) by sodium phosphotungstate-magnesium chloride. The patient's serum lipoproteins were analyzed after fractionation by density gradient ultracentrifugation. The alpha slow-moving HDL floated in the ultracentrifugation subfractions with densities ranging from 1.028 to 1.084 kg/L, and their main apolipoproteins included apolipoprotein E in addition to apolipoprotein A-I. These HDL were larger than HDL2. The pathogenesis of this unusual HDL subfraction is hypothesized.