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1病历资料患者男,73岁。因"反复便血4个月"于2011-09-27入我院。入院前4个月(2011年5月)患者进食辛辣食物后出现鲜血便,覆于大便表面,量约数滴。此后间断出现上述情况,自认为"痔疮"出血,未行诊治。20 d前(2011年9月)上楼时突发头晕、大汗、心悸,休息后缓解,院外查血常规示血红蛋白(Hb)66 g/L,白细胞(WBC)、血小板(PLT)、出凝血时间及肝肾功能正常。     

儿童幽门螺杆菌感染情况及其与上消化道症状的关系

[目的]探讨儿童幽门螺杆菌（Hp）感染与上消化道症状及胃黏膜病变的关系.[方法]纳入300例有上消化道症状患儿,Hp感染情况采用13C或尿素呼气试验或血清Hp抗体检查,204例患儿接受胃镜检查.[结果]①Hp阳性率为34.67％（103/300）,男女患者Hp阳性率差异无统计学意义（P＞0.05）,3～6岁、7～10岁及11～14岁年龄组Hp阳性率依次升高,组间差异有统计学意义（P＜0.05）;②胃镜检查显示39.21％患儿（80/204）有胃黏膜病变,Hp阳性者胃黏膜病变比例高于Hp阴性者（P＜0.05）;③Hp阴性者胃黏膜病变以轻-中度为主,而Hp阳性者胃黏膜病变以中-重度为主,两者病变严重程度的差异有统计学意义（P＜0.05）.[结论]有上消化道症状儿童Hp阳性率较高,且随年龄增长而增高,Hp感染与胃黏膜病变发生及严重程度相关.     

Primary gastrointestinal lymphoma

Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type.Although lymphoma can involve any part of the gastrointestinal tract,the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region.Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare.Gastrointestinal lymphomas are usually not clinically spec...     

Central nervous system involvement in AIDS‐related lymphomas

Central nervous system (CNS) involvement is reportedly more common in acquired immunodeficiency syndrome (AIDS)‐related lymphomas (ARL). We describe factors and outcomes associated with CNS involvement at baseline (CNS^B) and relapse (CNS^R) in 886 patients with newly diagnosed ARL. Of 886 patients, 800 received either intrathecal (IT) therapy for CNS^B or IT prophylaxis. CNS^B was found in 13%. CNS^B was not associated with reduced overall survival (OS). There was no difference in the prevalence of CNS^B between the pre‐combination antiretroviral therapy (cART) and cART eras. 5·3% of patients experienced CNS^R at a median of 4·2 months after diagnosis (12% if CNS^B; 4% if not). Median OS after CNS^R was 1·6 months. On multivariate analysis, only CNS^B [hazard ratio (HR) 3·68, P = 0·005] and complete response to initial therapy (HR 0·14, P < 0·0001) were significantly associated with CNS^R. When restricted to patients without CNS^B, IT CNS prophylaxis with 3 vs. 1 agent did not significantly impact the risk of CNS^R. Despite IT CNS prophylaxis, 5% of patients experienced CNS^R. Our data confirms that CNS^R in ARL occurs early and has a poor outcome. Complete response to initial therapy was associated with a reduced frequency of CNS^R. Although CNS^B conferred an increased risk for CNS^R, it did not impact OS.     

Duodenal ulcers dominate acute upper gastrointestinal tract bleeding in childhood: a 10-year experience from Hong Kong

OBJECTIVE: Systematic reports on acute upper gastrointestinal bleeding in children/adolescents are scanty. The aim of this study is to analyze its presentation, pathology and outcome in Hong Kong. METHODS: A retrospective review of the hospital database for admissions up to the age of 18 years with signs of acute upper gastrointestinal bleeding between 1 June 1996 and 31 May 2006. RESULTS: During the 10‐year period 76 patients (55 boys) were admitted with signs of upper gastrointestinal bleeding. The median age was 13.5 (range 0.25–18) years. Melena and hematemesis were by far the most frequent presentations. Medication was implicated in 16 cases (21%) as the possible cause for the bleeding. Endoscopic findings were a duodenal ulcer in 57 (75%) patients (50 boys) and a gastric ulcer in eight (10.5%). Helicobacter pylori infection was identified in 42 (55%) patients, of which 38 were found in duodenal ulcer patients. Eleven patients (14.5%) had interventions to achieve hemostasis: six epinephrine spray only, three thermal probe and two vessel ligation. After a median follow‐up time of 3.5 years six patients had a recurrent duodenal ulcer. Three patients died of unrelated illnesses. CONCLUSION: Acute upper gastrointestinal tract bleeding in children and adolescents in Hong Kong is dominated by a duodenal ulcer in 75% of the patients. Acute bleeding is more frequent in boys (boy to girl ratio 2.6:1). Medication is a predisposing factor in 20% of the bleedings. Six patients (8%) have recurrent duodenal ulcers.     

Regression of MALT lymphomas coexisting in the duodenal bulb and the stomach by eradication of Helicobacter pylori

Helicobacter pylori eradication. During an endoscopic examination, multiple polyps in the duodenal bulb were observed in a 62-year-old woman. The pathology of the duodenal polyps was low-grade B-cell MALT lymphoma. Gastric MALT lymphoma was also detected in biopsies of rough mucosa from the gastric corpus. Southern blot analysis showed rearranged bands of DNA immunoglobulin heavy chain J portion (IgH-J) in both lesions, but the positions of these bands were different in the two lesions. H. pylori was recognized in the gastric mucosa by positive serum H. pylori antibody and urease tests, while bacterial bodies were not found in the duodenal bulb. With 1 year after the successful eradication of H. pylori, both the lesions, that in the duodenal bulb and that in the gastric corpus, had disappeared. Furthermore, positive rearrangement of IgH-J was not found at either of the lesion sites. In May 2000, 3 years after the treatment, endoscopic surveillance failed to find any recurrence of these malignant lymphomas. Received: October 6, 2000 / Accepted: March 2, 2001     

Phase IA/II,multicentre, open‐label study of the CD40 antagonistic monoclonal antibody lucatumumab in adult patients with advanced non‐Hodgkin or Hodgkin lymphoma

Despite advancements in the treatment of non‐Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL), patients continue to relapse and thus a need for new targeted therapies remains. The CD40 receptor is highly expressed on neoplastic B cells and activation leads to enhanced proliferation and survival. Lucatumumab (HCD122) is a fully human antagonistic CD40 monoclonal antibody. A phase IA/II study was designed to determine the maximum tolerated dose (MTD) and activity of lucatumumab in patients with relapsed/refractory lymphoma. Determination of the MTD was the primary objective of the phase IA dose escalation portion and clinical response was the primary objective of the phase II dose expansion portion. Patients received escalating doses of lucatumumab administered intravenously once weekly for 4 weeks of an 8‐week cycle. MTD was determined at 4 mg/kg of lucatumumab. A total of 111 patients with NHL (n = 74) and HL (n = 37) were enrolled. Responses were observed across various lymphoma subtypes. The overall response rate by computed tomography among patients with follicular lymphoma (FL) and marginal zone lymphoma of mucosa‐associated lymphatic tissue (MZL/MALT) was 33·3% and 42·9%, respectively. Lucatumumab demonstrates modest activity in relapsed/refractory patients with advanced lymphoma, suggesting that targeting of CD40 warrants further investigation.     

Uncommon non‐Hodgkin lymphomas of childhood: pathological diagnosis,clinical features and treatment approaches

We provide a review of the pathological and clinical features for uncommon B‐cell and T‐cell lymphomas of childhood with a specific focus on advances in treatment approaches and outcomes. There is clearly a need for prospective investigation of both the clinical and biological features of the uncommon non‐Hodgkin lymphoma subtypes in childhood. These results should lead to more uniform and more effective treatment approaches.     

Lymphoma diagnosis at an academic centre: rate of revision and impact on patient care

Few studies have examined the value of a mandatory second review of outside pathology material for haematological malignancies. Therefore, we compared diagnoses on biopsies referred to an academic medical centre to determine the rate and therapeutic impact of revised diagnoses resulting from a second review. We reviewed 1010 cases referred for lymphoma during 2009–2010. For each case, referral diagnosis and second review diagnosis were compared. Revised diagnoses were grouped into major and minor discrepancies and all major discrepancies were reviewed by a haematologist to determine the effect the diagnostic change would have on therapy. There was no change in diagnosis in 861 (85·2%) cases. In 149 (14·8%) cases, second review resulted in major diagnostic change, of which 131 (12·9%) would have resulted in a therapeutic change. The highest rates of revision were for follicular, high‐grade B‐cell, and T‐cell lymphomas. We found higher rates of major discrepancy in diagnoses from non‐academic centres (15·8%) compared to academic centres (8·5%; P = 0·022), and in excisional biopsies (17·9%) compared to smaller biopsies (9·6%; P = 0·0003). Mandatory review of outside pathology material prior to treatment of patients for lymphoma will identify a significant number of misclassified cases with a major change in therapy.     

CD74 in antigen presentation, inflammation, and cancers of the gastrointestinal tract

CD74 is a protein whose initial role in antigen presentation was recognized two decades ago. Recent studies have revealed that it has additional functions as a receptor for macrophage migration inhibitory factor and as a receptor for an important human pathogen, Helicobacter pylori （H pylon）. The role of CD74 as a receptor is important because after binding of migration inhibitory factor or H pylori, NF-κB and Erkl/2 activation occurs, along with the induction of proinflammatory cytokine secretion. This review provides an up-to-date account of the functions of CD74 and how it might be involved in inflammation and cancer within the gastrointestinal tract.     

Disseminated lymphoblastic lymphoma in children and adolescents: results of the COG A5971 trial: a report from the Children's Oncology Group

The Children's Oncology Group's A5971 trial examined central nervous system (CNS) prophylaxis and early intensification in paediatric patients diagnosed with CNS‐negative Stage III and IV lymphoblastic lymphoma. Using a 2 × 2 factorial design, the study randomized patients to Children's Cancer Group (CCG) modified Berlin‐Frankfurt‐Muenster (BFM) acute lymphoblastic leukaemia (ALL) regimen with intensified intrathecal (IT) methotrexate (MTX) (Arm A1) or an adapted non‐Hodgkin lymphoma/BFM‐95 therapy with high dose MTX in interim maintenance but no IT‐MTX in maintenance (Arm B1) . Each cohort was randomized ± intensification (cyclophosphamide/anthracycline) (Arms A2/B2). For the 254 randomized patients, there was no difference in 5‐year event‐free survival (EFS) for the four arms: Arm A1 , 80% [95% confidence interval (CI) 67–89%] and Arm A2 , 81% (95% CI 69–89%); Arm B1 , 80% (95% CI 68–88%) and Arm B2 , 84% (95% CI 72–91%). The cumulative incidence of CNS relapse was 1·2%. Age <10 years and institutional imaging response at 2 weeks was associated with improved outcomes (P < 0·001 and P = 0·014 for overall survival). CNS positive patients (n = 12) did poorly [5‐year EFS of 63% (95% CI 29–85%)]. For CNS‐negative patients, there was no difference in outcome based on CNS prophylaxis (IT‐MTX versus HD‐MTX) or with intensification.     

原发性胃黏膜相关淋巴组织淋巴瘤29例临床分析

目的：分析胃黏膜相关淋巴组织（MALT）淋巴瘤临床、胃镜、病理特征,提高早期检出率。方法：回顾性分析经胃镜活检及手术后病理证实胃MALT淋巴瘤29例患者的临床资料。结果：29例患者临床表现多样,以上腹痛多见,幽门螺杆菌（HP）感染率高达93%,胃镜下病灶好发于胃窦、胃体,但胃镜下活检阳性率较低,仅占48%。结论：胃MALT淋巴瘤临床表现无特异性,胃镜下表现多样,提高临床和胃镜医师对本病的认识以及提高胃镜下活检阳性率活检标本加做免疫组织化学染色是早期诊断胃MALT淋巴瘤的关键。     

肝硬化上消化道出血和幽门螺杆菌感染的相关性研究

目的研究肝硬化患者幽门螺杆菌感染和上消化道出血之间的关系.方法肝硬化患者160例,内镜检查了解食管静脉曲张和消化性溃疡的发生情况及出血的原因,同时胃粘膜活检作尿素酶试验,检测幽门螺杆菌(Hp).结果Hp阳性组消化性溃疡发生率(64.1%)明显高于阴性组(37.8%,P＜0.01).出血率在Hp阳性组(38.5%)也明显高于阴性组(22%,P＜0.05).结论Hp感染和肝源性溃疡发生有关,Hp感染者的肝源性溃疡发生率增高及胃粘膜活动性炎症可能导致出血率升高,根除Hp有可能降低肝硬化上消化道出血.     

Predictors of delay in diagnosis and treatment in diffuse large B‐cell lymphoma and impact on survival

There is a paucity of data on the impact of diagnostic and treatment delays on outcomes in haematological malignancies, particularly in patients with diffuse large B‐cell lymphoma (DLBCL). Our database of patients treated for DLBCL between 2002 and 2010 was interrogated. Univariate and multivariate analyses were performed to determine the relationship between sociodemographic or disease‐specific variables and delays. Cox Regression analysis was used to discern the impact of delays on survival. Patients (n = 278) waited a median of 4 weeks before seeking medical attention. It took a median of 8 weeks for a non‐haematology physician to diagnose DLBCL and refer to a haematologist. A median of 3 weeks elapsed between specialist consultation and chemotherapy initiation. In multivariate logistic regression analysis, bone marrow involvement [odds ratio (OR) = 0·41, P = 0·018], Charlson comorbidity index (OR = 1·42, P = 0·017) and urgent inpatient chemotherapy (OR = 0·40, P = 0·012) were associated with diagnostic delays >6 weeks. Lack of pathological diagnosis at the time of haematology referral was the only factor that independently predicted for treatment delays >4 weeks (OR = 8·25, P < 0·01). Diagnostic or treatment delays did not impact survival or progression‐free survival. In conclusion, selected disease and patient‐related factors are associated with delays in management of DLBCL, but do not impact outcomes.