卵巢透明细胞癌21例临床病理分析

目的:探讨卵巢透明细胞癌的临床及病理特点。方法:回顾性分析21例卵巢透明细胞癌患者的临床、病理特点、治疗和预后情况。结果:术中发现有腹水且多脏器浸润。病理表现特征性的透明细胞和鞋钉细胞。免疫组化CK(+)14例,leu M1(+)5例,甲胎蛋白(+)2例,Vimentin均阴性。Ⅰ～Ⅱ期7例,2年及5年生存率为85.7%及57.1%,Ⅲ～Ⅳ期14例,2年及5年生存率则为57.1%及28.6%(P<0.05),总的5年生存率为38.1%。结论:卵巢透明细胞癌预后不良,手术和化疗为主要治疗方式,放疗可以延长生存期。Ⅲ～Ⅳ期患者较Ⅰ～Ⅱ期预后更差。     

卵巢透明细胞癌与子宫内膜异位症——附45例临床病理分析

目的　探讨伴子宫内膜异位症或其他恶性上皮性肿瘤的卵巢透明细胞癌临床病理特点及预后。方法　随访并回顾性分析 45例原发性卵巢透明细胞癌患者 ,对病理学特征和临床特征的相关性作统计学分析。结果　以腹痛、腹胀、盆腔肿块为主要症状者占 73.3%。术前拟诊为卵巢内膜样囊肿或子宫内膜异位症者占44 .4%。根据FIGO分期 ,Ⅰ期 2 6例、Ⅱ期 6例、Ⅲ期 12例、Ⅳ期 1例。术后病理证实 ,伴子宫内膜异位症 2 8例 ,占 6 2 .2 % ;不伴子宫内膜异位症 17例 ,占 37.8%。Ⅰ期 2 6例中伴子宫内膜异位症 19例 ;不伴子宫内膜异位症 7例。 45例中单纯卵巢透明细胞癌 19例 ,占 42 .2 % ;混合型卵巢透明细胞癌 2 6例 ,占 5 7.8% ;其中 2 0例(76 .9% )合并卵巢宫内膜样癌 ,5例 (13.2 % )合并浆液性囊腺癌 ,1例 (3% )合并黏液性囊腺癌。结论　伴子宫内膜异位症的卵巢透明细胞癌 ,因自觉症状明显 ,就诊早 ,容易被发现 ,故Ⅰ期病例较多。因这类患者术前常被误诊为子宫内膜异位症 ,所以对临床诊断为卵巢内膜样囊肿或子宫内膜异位症的患者必须严密随访 ,不宜一味保守治疗 ,也不宜采用穿刺抽囊液方法 ,以免遗漏可能早期发现的卵巢透明细胞癌。单纯和混合型 ,伴与不伴子宫内膜异位症的卵巢透明细胞癌 ,预后差异无显著性 (P >0 .0     

53例卵巢透明细胞癌的临床特点和预后因素分析

目的探讨卵巢透明细胞癌（OCCC）的临床特点和预后因素分析。方法回顾性分析1990年1月-2007年12月53例原发性卵巢透明细胞癌患者临床资料,对其临床特点与治疗情况进行总结并分析其预后。结果 53例卵巢透明细胞癌占本院同期卵巢上皮癌的4.3%,Ⅰ期患者23例,5年生存率43.48%;Ⅱ期患者15例,5年生存率26.67%;两者比较有统计学差异（P=0.016）;Ⅰ-Ⅱ期5年生存率36.84%;Ⅲ期患者15例,5年生存率28.67%,两者比较有统计学差异,P=0.01。Ⅰ＋Ⅱ期患者理想/不理想的肿瘤细胞减灭术5年生存率分别为40%/0;Ⅲ期理想/不理想的肿瘤细胞减灭术5年生存率20%/0,差异有显著性（P〈0.02、P〈0.03）。手术＋化疗＋生物治疗组与手术＋化疗组5年生存率比较无统计学差异,P=0.43;手术＋化疗＋放疗组的5年生存率50%,与手术＋化疗组相比较有统计学意义,P=0.02。结论卵巢透明细胞癌临床分期早,但预后差,影响预后的因素为临床分期、是否行理想的肿瘤细胞减灭术及治疗方式。术后联合放疗、生物治疗,可望改善预后。     

CAP方案治疗卵巢上皮性癌178例远期疗效分析

目的　分析178例接受CAP(环磷酰胺、卡铂/顺铂、多柔比星)方案化疗的卵巢上皮性癌患者远期疗效。方法　回顾性分析178例手术及病理证实的卵巢上皮性癌I～IV期患者术后接受CAP方案化疗疗效。分析比较各期、各病理类型及不同年龄患者术后无瘤生存率。结果Ia、Ib c、Ⅱ、Ⅲ期患者术后5年无瘤生存率分别为:96 .4 %、73.0 %、5 3.6 %、2 5 .8%。IV期4年无瘤生存率为0。Ⅱ期以上透明细胞癌患者术后4年生存率与浆液性细胞癌(P =0 .0 189)、内膜样腺癌(P =0 .0 35 8)差异有显著意义。各年龄组无瘤生存率(P =0 .0 917)无显著差异。结果　CAP方案仍可作为早期卵巢上皮性癌的常规治疗方案,但对透明细胞癌、铂类治疗后复发性癌及晚期卵巢上皮性癌应选用更有效的治疗方案。结论　CAP方案仍可作为早期卵巢上皮性癌的常规治疗方案,但对透明细胞癌、铂类治疗后复发性癌及晚期卵巢上皮性癌应选用更有效的治疗方案。     

子宫内膜癌的生存分析及预后因素探讨

目的 对子宫内膜癌进行生存分析及预后因素探讨.方法 选择山西省肿瘤医院1983-02～1998-02间收治的215例子宫内膜癌患者,回顾分析所有患者的临床、病理及随访资料,进行子宫内膜癌患者生存分析及子宫内膜癌患者预后的影响因素分析.结果 215例患者5年生存率为86.25%,I、Ⅱ、Ⅲ-Ⅳ期患者的5年生存率分别为96.00%,80.49%,33.33%.I、Ⅱ期的5年生存率明显高于Ⅲ-Ⅳ期(P＜0.05);单纯腺癌及腺棘癌的5年生存率明显高于其他类型癌(P＜0.05).COX回归分析显示:单因素分析表明手术分期、病理类型、绝经、手术切除范围、组织分级、肌层浸润是影响子宫内膜癌预后的相关因素.在多因素分析中,绝经、病理类型、组织学分级、肌层浸润、手术切除范围是影响子宫内膜癌预后的独立因素.结论 子宫内膜癌的5年生存率较高.绝经、病理类型、组织学分级、肌层浸润、手术切除范围是影响子宫内膜癌预后的因素.     

晚期上皮性卵巢癌的预后影响因素

目的　研究Ⅲ期、Ⅳ期上皮性卵巢癌 (EOC)的预后影响因素。方法　回顾分析了最近 12年本院收治的 2 6 5例Ⅲ期、71例Ⅳ例EOC资料。采用寿命表法计算生存率 ,Kaplan Meier描绘生存曲线 ,log rank检验生存率差异 ;Cox逐步回归法分析影响预后的因素。结果　Ⅲ、Ⅳ期EOC总的 5年生存率分别为 2 1.97%、6 .12 % ,残癌≤ 1cm者的生存率分别达到 38.5 6 %、14.12 %。Cox逐步回归分析结果表示 ,残留灶 >1cm(P =0 .0 0 0 0 )、肿瘤侵犯子宫肌层 (P =0 .0 0 2 9)、有难治性腹水 (P =0 .0 0 0 0 )和透明细胞癌 (P =0 .0 0 3 8)是影响Ⅲ期EOC总体生存率的危险因素 ;而黏液性癌和接受辅助静脉和腹腔化疗组预后好。另外残留灶大小、难治性腹水、新辅助化疗还与无疾病进展生存期 (progression freesurvival,PFS)有关。除残癌大小 (P =0 .0 0 14)外 ,腹水 (P =0 .0 0 43)还是Ⅳ期EOC的预后因素。结论　残癌大小、难治性腹水、组织类型、辅助化疗是晚期EOC的主要预后影响因素 ,腹水还是Ⅳ期EOC的预后影响因素     

子宫肉瘤30例临床分析

目的探讨子宫肉瘤的临床特点和影响预后的相关因素.方法回顾性分析1985～2000年该院收治的30例子宫肉瘤患者,其中子宫平滑肌肉瘤18例,子宫内膜间质肉瘤8例,恶性中胚叶混合瘤4例.Ⅰ期14例,Ⅱ期1例,Ⅲ期8例,Ⅳ期7例.结果子宫肉瘤临床表现以不规则阴道流血为主要症状(60%),其次为下腹痛(40%)、盆腔包块(26.7%)、阴道排液(3.3%)等.子宫肉瘤体征主要表现为子宫增大,子宫大于妊娠3月大小者占93.3%;术前确诊率低(13.3%),术前仅4例经分段诊刮确诊,均为子宫内膜间质肉瘤;治疗:所有病例均行手术治疗.术后化疗5例,放疗4例,术前化疗1例,术前放疗1例;预后:2年生存率80%,5年生存率45%.Ⅰ～Ⅱ期5年生存率35%,Ⅲ～Ⅳ期无1例活过5年.结论子宫肉瘤临床表现无特异性,以不规则阴道流血为主.诊断性刮宫是早期诊断子宫肉瘤的方法.治疗以手术治疗为主,辅以化疗或放疗.子宫肉瘤预后差,预后主要与临床期别、病理类型等有关.     

腮腺癌术后放射治疗的临床分析

目的 :回顾分析腮腺癌术后放射治疗的作用及其预后因素。方法 :1 991年 1月～ 1 994年 1 2月 ,2 5例经病理证实的腮腺癌 (Ⅰ期 2例 ,Ⅱ期 5例 ,Ⅲ期 1 2例 ,Ⅳ期 6例 )术后采用60 Coγ线和 1 80kVX线或直线加速器电子束进行放射治疗 ,并随防 5年以上。结果 :全组 5年生存率为 72 % ,5年局部控制率为 88.0 %。术后放疗以 5 0～ 6 0Gy剂量组疗效好 ,5年生存率为 85 .7%。低分化腺癌及未分化癌预后较差。结论 :腮腺癌应提倡手术加放射的综合治疗 ,采用光子束和电子束混合线照射 ,肿瘤剂量予 5 0～ 6 0Gy为宜。临床分期及病理类型为重要预后因素     

子宫内膜癌74例临床分析

目的回顾性总结74例子宫内膜癌各期盆腔淋巴结转移情况;手术分期与病理分期的差异及肉眼观察大体标本与病理检查结果符合率,从而指导临床手术范围及术后采取的辅助治疗措施.方法将子宫内膜癌病理分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期的淋巴转移情况,手术分期情况与病理分期的差异情况,不同组织类型的子宫内膜癌肉眼观察结果与病理结果,进行统计分析.结果子宫内膜癌Ⅰ、Ⅱ、Ⅲ、Ⅳ的淋巴转移率分别为0、16.7%、25%、50%.其Ⅰ、Ⅱ、Ⅲ期的临床误判率分别为10%、40%、94%,Ⅳ期仅有2例,其中1例误判.子宫肌层浸润情况统计:子宫内膜腺癌肉眼观察与病理结果符合率为83.8%,子宫内膜乳头状囊腺癌与透明细胞癌的肉眼观察与病理结果符合率仅为42%.结论子宫内膜癌的盆腔淋巴转移率随病理分期增高而升高.且较早出现淋巴转移,故应以病理检查为依据指导临床手术范围及辅助治疗.     

肾盂移行细胞癌的CT诊断

目的 :评价CT对肾盂移行细胞癌的分期及其临床应用价值。　方法 :32例经手术及病理证实的肾盂移行细胞癌患者术前均经CT扫描。根据CT表现分为Ⅰ～Ⅱ期 (病理Ⅰ～Ⅱ级 ) :肾盂壁增厚或肾盂内肿块 ,肾盂外脂肪清晰 ;Ⅲ期 (病理Ⅲ级 ) :肾盂内肿瘤侵及肾盂外脂肪或肾实质 ;Ⅳ期 (病理Ⅳ级 ) :肿瘤侵及肾外 ,淋巴结肿大或有远处转移。　结果 :CT诊断Ⅰ～Ⅱ期 7例 ,Ⅲ期 2 0例 ,Ⅳ期 5例。而术后病理证实Ⅰ级 1例 ,Ⅱ级 5例 ,Ⅲ级 2 1例 ,Ⅳ级 5例。　结论 :CT扫描是对肾盂癌进行术前分期的有效方法     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.