Analysis of pathogenic factors of radiation encephalopathy after radiotherapy for nasopharyngeal carcinoma

Ａｎａｌｙｓｉｓｏｆｐａｔｈｏｇｅｎｉｃｆａｃｔｏｒｓｏｆｒａｄｉａｔｉｏｎｅｎｃｅｐｈａｌｏｐａｔｈｙａｆｔｅｒｒａｄｉｏｔｈｅｒａｐｙｆｏｒｎａｓｏｐｈａｒｙｎｇｅａｌｃａｒｃｉｎｏｍａ￥ＺｈａｎｇＸｕｅｌｉｎ（张雪林）；ＹａｎＷｅｉｐｉｎｇ（阎...     

Magnetic resonance imaging in diagnosis of radiation encephalopathy after radiotherapy for nasopharyngeal carcinoma

ＭａｇｎｅｔｉｃｒｅｓｏｎａｎｃｅｉｍａｇｉｎｇｉｎｄｉａｇｎｏｓｉｓｏｆｒａｄｉａｔｉｏｎｅｎｃｅｐｈａｌｏｐａｔｈｙａｆｔｅｒｒａｄｉｏｔｈｅｒａｐｙｆｏｒｎａｓｏｐｈａｒｙｎｇｅａｌｃａｒｃｉｎｏｍａＺｈａｎｇＸｕｅｌｉｎ（张雪林）；ＹａｎＷｅ...     

MRI-T2 values in the differentiation of recurrence and fibrosis after radiation of nasopharyngeal carcinoma.

The possibility of T2 values in the differentiation of local recurrence and irradiation fibrosis was studied prospectively in 36 patients with nasopharyngeal carcinoma (NPC) after radiotherapy. All the patients had a soft-tissue mass in the nasopharynx demonstrated by CT. Fourteen patients had tumor recurrence, 20 radiation fibrosis, 1 postradiation edema, and 1 inflammatory change. The control group consisted of 8 patients with untreated NPC. It was found that T2 was longer in patients with tumor than in patients with radiation fibrosis. We conclude that MRI may be used as a noninvasive method for differentiating radiation fibrosis from local recurrent NPC, but the prolonged T2 value of tumor is not specific and may be seen in radiation edema and infection.

     

Genital carcinoma after radiotherapy for carcinoma of the cervix. Report of two cases.

Two cases of genital carcinoma were found after radiotherapy for carcinoma of the cervix. Vulval carcinoma occurred 30 years after radiation with initial symptoms of itching and whitish changes of the skin at the external genitalia. Adenocarcinoma of the endometrium occurred 9 years after radiation and diffused intra-abdominal metastasis was found surgically. The sites of second malignancies following irradiation for cervical carcinoma and the time interval between them were reviewed. The characteristics of the post-radiation vulval carcinoma and the endometrial carcinoma were discussed.

     

Association of E-cadherin and β-catenin with metastasis in nasopharyngeal carcinoma

Background This study was designed to detect methylation of E-cadherin gene promoter and gene mutation of β-catenin in exon 3 and their expression of protein and mRNA in primary tumor and lymph node metastatic tumor of nasopharyngeal carcinoma (NPC), and investigate the mechanism of invasion and metastasis of neoplastic cells in NPC. Methods Fourty-two fresh biopsy samples were taken from untreated NPC patients at the Affiliated Hospital of Sun Yat-sen Medical College, Sun Yat-sen University, Guangzhou, China during the period of 1999 -2002. Among them 21 were taken from primary tumors and the other 21 from lymph node metastatic tumors. The gene promoter methylation of E-cadherin was detected by methylation-specific PCR (MSP). The mutation in exon 3 of β-catenin was detected by direct sequencing analysis. RT-PCR, Western blot and immunohistochemical staining were used to detect the mRNA and protein expression patterns in both primary and metastatic tumors of NPC. Results Down-regulated expression of E-cadherin in metastatic tumor was compared with that in primary tumor. Reduced expression of E-cadherin was found to be correlated with lymph node metastatic tumor of NPC ( P = 0. 004) ; but there was no obvious correlation between primary and metastatic tumors in the expression of β-catenin (P = 0. 698). The mRNA expression level of Ecadherin in metastatic tumors decreased significantly compared with that in primary tumors. However, little change was observed in the mRNA level of β-catenin in different tumor tissues. Only 4 samples (19. 1%) displayed gene promoter methylation of E-cadherin in primary tumor and 10 samples (47. 6%) showed methylated form of E-cadherin. The gene promoter methylation of E-cadherin was more common in metastatic tumor than in primary tumor of NPC ( P =0. 024). Only 2 (4. 76% ) of the 42 samples showed mutations in exon 3 of β-catenin at 41 (T41A, ACC→GCC) and codon 47(S47T, AGT→ACT). The cytoplasmic and nuclear expression of β-catenin in tumor was not found in any samples of NPC. Conclusions The results suggest that the downregulation of E-cadherin results from the gene promoter aberrant methylation of E-cadherin and that the methylation of E-cadherin plays an important role in invasion and metastasis of tumor cells in NPC. However, β-catenin mutation is an infrequent event in NPC, and β-catenin is not a critical factor influencing the invasion and metastasis of tumor cells in NPC.     

Clinical manifestations and prevalence of different types of supraventricular tachycardia among Chinese.

Sixty-nine cases of paroxysmal supraventricular tachycardia (PSVT) were submitted to electrophysiological studies. The prevalence of different types of PSVT is as follows: 49% of the cases had atrioventricular reentry tachycardia (AV-RT), 14.5% atrioventricular nodal reentry tachycardia (AVN-RT), 28% AV + AVN - RT, and 8.5% other types. Altogether 77% in this group had atrioventricular accessory pathway, of which half are concealed pathway. Electrocardiographic characteristics during tachycardia give hints to diagnosis: (1) AV - RT has the fastest heart rate, with 62% 200 BPM or more, and 82% more than 188 BPM; (2) retrograde P waves can be detected in 64% of cases with AV bypass; (3) 50% of AV - RT shows QRS of bundle branch block pattern. Since accessory pathways are present in the majority of PSVT patients in China, the importance of treatment is stressed.

     

Clinical significance of survivin in the diagnosis and prognosis of endometrial carcinoma

Objective： To investigate the clinical significance of survivin in endometrial carcinoma and to investigate the relationship between the expression of survivin and Ki-67. Methods： Immunohistochemical S-P （streptavidin-biotin-peroxidase complex）method was performed to detect the expression of survivin and Ki-67 antigen in 15 cases of normal endometrium, 21 cases of endometrial simple and complex hyperplasia, 22 cases of endometrial atypical hyperplasia, and 61 cases of endometrial carcinoma. Results： Survivin was hardly detected in some normal endometrium in the proliferative phase and in the secretory phase. However, the level of survivin expression in atypical hyperplasia endometrium（72.73%）was higher than that in normal en- dometrium （7.14%）（P 〈 0.05）, including simple and complex hyperplasia （42.38%）（P 〈 0.01 ）, and was lower than that in endometrial carcinoma（90.17%）（P 〈 0.05）. Moreover, significant correlation was present between the expression of survivin and the characteristics of endometrial carcinoma, including clinical stage, histological grade and the presence of invasion to myometrium （P 〈 0.05）. In addition, Ki-67 antigen expression was positively correlated with survivin expression in all specimen. Ki-67 labeled indexes （LIs）in hyperplasia endometrium were significantly lower than those in atypical hyperplasia endometrium and endometrial carcinoma （P 〈 0.01 ）, while there was no significant difference in Ki-67 LIs between atypical hyperplasia endometrium and endometrial carcinoma（P 〉 0.05）. There was no significant relationship between Ki-67 LIs and the characteristics of endometrial carcinoma, including histological grade, clinical stage or the invasion to myometrium（P 〉 0.05）. Conclusion： Survivin may participate in the onset and progression of endometrial carcinoma through inhibiting apoptosis and promoting proliferation. Survivin expression is correlated with the malignant degree and prognosis of tumor. Ki-67 is also associated with carcinogenesis and progression of endometrial carcinoma. The results suggest that survivin could be a diagnostic and prognostic marker for endometrial carcinoma and might provide pathways to treat the patients with recurrent or refractory or rudimental endometrial carcinoma.     

Clinical features and comprehensive treatment of late stage radiation skin injuries.

105 patients with late stage radiation skin injury were treated from 1970 to 1986, using drugs combined with surgical intervention according to the clinical features of the injury. Drug therapy consisted of topical application of urea, antibiotics, trypsin and elastase, and systematic use of alpha 2-Macroglobulin. Of 62 patients receiving medication, 55 (88.7%) were completely or basically treated and 7 failed. Of 51 lesions of 43 patients receiving surgical treatment, 47 healed by first intention. In 4 patients, necrosis of partial and/or peripheral skin flaps healed after renewed repair.

     

A comparative study on the angiogenic activity of condyloma acuminatum and basal cell carcinoma

Ａｃｏｍｐａｒａｔｉｖｅｓｔｕｄｙｏｎｔｈｅａｎｇｉｏｇｅｎｉｃａｃｔｉｖｉｔｙｏｆｃｏｎｄｙｌｏｍａａｃｕｍｉｎａｔｕｍａｎｄｂａｓａｌｃｅｌｌｃａｒｃｉｎｏｍａ（曾抗）；ＷａｎｇＲｕｉｓｈａｎ（王瑞善），ＷａｎｇＨｏｎｇｔａｏ（王鸿涛）；ＷｕＲａ...     

鼻咽癌放疗后放射性脑病发生率对比分析

采用两种放疗方案对NPC进行治疗，并比较其REP的发生率。REP的发生率采用新法的A组为6．4％，传统法的B组为18．7％，两组结果有显著性差异（P＜0．05）。预防REP发生的主要措施为：按照“小而不漏”的原则设野，严格控制放疗总量及分割次数。     

鼻咽癌单程与再程放射治疗后放射性脑损伤临床分析

目的探讨鼻咽癌单程与再程放疗后放射性脑损伤(REP)的临床特点。方法回顾性分析2 103例鼻咽癌放疗患者的临床资料,总结单程放疗后REP和再程放疗后REP患者的临床特点。结果鼻咽癌再程放疗患者REP发生率(9.60%)明显高于单程放疗者(2.07%,P<0.05);再程放疗后REP组REP中位潜伏期(2 a)明显短于单程放疗后REP组(5 a,P<0.05);再程放疗后REP组REP患者死亡率(33.3%)明显高于单程放疗后REP组(7.32%,P<0.05)。结论鼻咽癌放疗后REP发生部位与放疗程数无明显相关性,但放疗后REP发病率、中位潜伏期、及患者死亡率与放疗程数有明显相关性。     

鼻咽癌放射性脑病的诊断和治疗

目的分析鼻咽癌放射性脑病（ＲＥＰ）的诊断和治疗方法。材料和方法为２８例鼻咽癌放疗后放射性脑病患者行ＣＴ检查,其中１０例又行ＭＲＩ检查,９例在我院接受治疗。结果和结论（１）ＣＴ对鼻咽癌放射性脑病的诊断有一定价值,但ＭＲＩ对后颅窝和脑干病变的显示优于ＣＴ;（２）放射性脑病可能是放疗致脑组织血管损伤后引起免疫改变的结果：（３）本组９例患者经应用激素、甘露醇、多种维生素等治疗,均取得不同程度的改善。因此．建议对鼻咽癌放疗后放射性脑病积极尽快治疗。     

PET/CT imaging of delayed radiation encephalopathy following radiotherapy for nasopharyngeal carcinoma

Background With the significant improvement in the survival of patients with nasopharyngeal carcinoma （NPC） undergoing radiotherapy and the growing availability of the sophisticated imaging modalities, the number of radiation encephalopathy （RE） cases relating to NPC radiotherapy is increasing. In this study, we investigated the metabolic and density changes of the compromised brain tissues during delayed RE using a positron-emission tomography-computed tomography （PET/CT） to provide clinical evidences for the diagnosis of delayed RE following radiotherapy for NPC. Methods The PET/CT manifestations and the clinical data of 53 pathologically confirmed NPC patients with delayed RE following radical radiotherapy and 15 healthy volunteers were investigated. The standardized uptake values （SUV） of the bilateral temporal lobes, the occipital lobe and the brain stem were measured respectively; and then the metabolic reduction rate of 88 temporal lobes and 13 brain stems were calculated for a statistical comparison between the two groups. Results The earliest case of delayed RE in the investigated patients occurred 1.5 years after radiotherapy. Delayed RE frequently involved the inferior temporal lobe. For patients with delayed RE confirmed by clinical symptoms and imaging findings, PET maintained a 100% coincidence rate with CT; however, in the 25 temporal lobes of the 35 delayed RE patients, PET revealed obvious hypometabolic changes whereas CT displayed normal density. The incidence of brain stem metabolic reductions was 24.5% （13/53） in the investigated patients, including 4 patients with hypometabolic changes shown by PET and negative finding shown by CT. The incidence of granuloma adjacent to the hypometabolic region in the temporal lobe was 12.5% （11/88）. Conclusion Delayed RE patients exhibit significant hypometabolic changes in the inferior temporal lobe, captured by PET much earlier than by CT. PET/CT offers a valuable means for the diagnosis of delayed RE in subacute stages and granuloma formation.     

鼻咽癌放疗后迟发性放射性脑病的PET/CT影像分型

目的 研究鼻咽癌放疗后放射性脑病(RE)的PET/CT影像学表现,观察大脑颞叶的代谢改变规律,根据其影像学表现进行分型.以期为放射性脑病的准确诊断提供诊断依据和标准.方法 本组共53例均为鼻咽癌(经活检病理确诊)行根治性放疗后,经过临床症状及CT和(或)MRI平扫加增强诊断为RE的患者.患者均依次进行全身和头部的扫描成像;并将临床资料与PET/CT影像学资料相结合进行分析.结果 最常见的放射性脑病累及的部位是双侧或单侧颞叶下极.本组中PET显示双侧颞叶代谢均明显降低者35例(即70个颞叶),单侧颞叶代谢减低者18例(即18个颞叶).根据PET/CT的影像学表现,将所有病例分为三型:水肿型(56个颞叶)、液化坏死型(10个颞叶)及萎缩钙化型(22个颞叶).1例水肿型的患者经过及时治疗后,病变区脑组织水肿完全恢复正常密度,代谢也恢复至正常;但2例水肿型进一步加重演变为萎缩钙化型;2例液化坏死型演变为萎缩钙化型.结论 根据RE的PET/CT表现将其分为水肿型、液化坏死型及萎缩钙化型共三型;第一、第二型可以向第三型演变.     

丹参酮联合克拉霉素治疗鼻咽癌放疗后鼻-鼻窦及咽部损伤

目的观察丹参酮与克拉霉素联合用药对鼻咽癌放疗后鼻-鼻窦及咽部损伤的治疗效果,以探索鼻咽癌放疗后鼻-鼻窦及咽
部损伤的最佳治疗方案。方法将255例中放疗后出现鼻-鼻窦及咽部损伤的鼻咽癌患者,按发生时间顺序随机分为克拉霉素组
（A组）丹参酮组（B组）以及克拉霉素+丹参酮联合用药组（C组）,观察各组的治疗预后情况。结果A、B、C 3组均有治疗效果,与
治疗前比较差异具有统计学意义（P<0.05）;A组与B组之间疗效差异不明显（P>0.05）;而C组的疗效明显好于A组和B组（P<
0.05）。结论多元化治疗是鼻咽癌放疗后鼻窦及咽部损伤治疗的趋势,克拉霉素+丹参酮联合用药是治疗鼻咽癌放疗后鼻窦及
咽部损伤非常有效的手段和方法。
     

鼻咽癌放疗后放射性脑病的磁共振氢波谱研究

目的 探讨鼻咽癌放疗后放射性脑病的磁共振氢波谱(1H-MRS)表现,了解N-乙酰天门冬氨酸(NAA)、肌酸(Cr)和胆碱(Cho)3种物质的代谢规律,为放射性脑病的早期诊断提供方法.方法 选取10例健康志愿者作为对照组,21例病理诊断为鼻咽癌并进行根治性放疗后经症状及影像学诊断为放射性脑病的病人作为病例组,用化学位移成像法(CSI)行1H-MRS检查.观察各像素中NAA、Cr和Cho的含量、代谢图及它们之间的比例.结果 磁共振成像(MRI)可见放射性脑病病灶中的液化坏死区3种物质含量基本为零,代谢图中无信号;病灶中非液化坏死区NAA轻度升高,Cr和Cho明显降低或为零,NAA代谢图呈高信号,Cr和Cho低信号.病灶周边存在一个区域NAA降低,Cf和Cho升高,NAA/Cr和NAA/Cho＜1,代谢图中信号区分不明显.远离可见病灶的区域NAA、Cr和Cho含量及比例正常.结论 1H-MRS可显示放射性脑病的物质代谢变化规律,发生变化的区域面积大于MRI中可见病变区,从而为该病的早期诊断提供了可能.     

鼻咽癌放疗后患者的放射性脑病与智能精神状态研究

目的：分析广东地区鼻咽癌放疗后放射性脑病（radiation encephalopathy,RE）的临床和影像学特点,并对放射性脑病患者智能精神状态及其影响因素进行研究。方法：分析121例RE患者的临床资料,采用简易智能精神状态检查量表（MMSE）对63例RE患者（病例组）和66例疗程匹配的鼻咽癌放疗后无放射性脑病患者（对照组）进行评定。系统分析放射性脑病患者智能精神状态的变化、影响因素及与神经系统症状的相关性。结果：二程放疗后6个月内RE的发生率较一程放疗者差异有统计学意义（P〈O．05）;首发症状以球麻痹症状（65例,53．7l％）最常见。对照组MMSE评分为（25．38±1．98）分,病例组MMSE评分为（23．03±2．69）分,对照组智能精神状态的评分高于病例组（P〈0．05）;一程放疗组MMSE评分为（23．55±2．26）分,二程放疗MMSE评分为（21．29±3．41）分,两组评分比较。差异有统计学意义（P〈0．05）。球麻痹症状与智能精神状态的评分呈负相关。结论：二程放疗后RE发病率在2年内明显增加。RE对患者智能精神状态存在一定的负性影响,其中球麻痹等症状对智能精神状态的负面作用将会被考虑进来。