Survivin在胆囊腺瘤组织中的表达意义及病理诊断价值分析

目的检测凋亡抑制蛋白Survivin在胆囊腺瘤的表达部位及形态特点,研究其与胆囊腺瘤发生、发展的相关性,并探讨其在胆囊腺瘤病理诊断中的应用价值。方法采用免疫组织化学技术检测25例胆囊腺瘤中Sur-vivin的表达。结果25例胆囊腺瘤中,23例Survivin蛋白胞浆阳性表达。其中21例核上表达,包括核上核样表达17例、核上泥沙样表达4例。另外胞浆弥漫表达2例。结论Survivin在胆囊腺瘤中高表达,具有向胆囊癌转化趋势,并且其特殊的表达部位及形态,在病理诊断中有着重要的应用价值。     

Primary Gastric Plasmacytoma: A Morphological and Immunohistochemical Study of Five Cases

Five cases of primary gastric plasmacytoma were studied histopathologically and immunohistochemically. Plasmacytoid cells proliferated diffusely in the propria mucosa, almost preserving the structure of gastric glands. Occasionally, intranuclear inclusions, giant cells, and needle-shaped crystalline inclusions were observed. The neoplastic nature could be suspected on the basis of these histological findings. Immunohistochemically, three cases were positive for IgM and two for IgA. IgM positivity was more commonly observed in the gastric plasmacytoma than in multiple myeloma. Another immunohistochemical study demonstrated that LN-1 negativity and anti-EMA antibody positivity might be an indicator to differentiate gastric plasmacytoma from other types of gastric lymphoma. Four cases of early-stage gastric plasmacytoma have been followed for 5-12 yr. No recurrence has been observed so far. These cases suggest that gastric plasmacytoma has a relatively good prognosis.     

Effect of Gamma Knife Radiosurgery on a Pituitary Gonadotroph Adenoma: A Histologic,Immunohistochemical and Electron Microscopic Study

The morphologic findings in a pituitary macroadenoma removed from a 65-year old man by the transsphenoidal approach 9 months after gamma knife surgery are reported. The tumor was immunoreactive for FSH and showed ultrastractural features consistent with an oncocytic gonadotroph adenoma. Accumulation of connective tissue separating small groups of adenoma cells was evident. Several dilated vessels and numerous vascular endothelial growth factor immunopositive adenoma cell were noted. By electron microscopy the endothelial linings frequently showed discontinuities with platelet accumulation attached to the gaps. Several vessels were severely injured showing necrosis of endothelial cells. It can be concluded that gamma knife surgery caused severe alterations in pituitary adenoma microcirculation indicating that vascular injury plays a crucial role in tumor shrinkage.     

Gallbladder Sarcoma: A Clinicopathological Study of Seven Cases from the UK and Austria with Emphasis on Morphological Subtypes

Background Primary sarcoma of the gallbladder (PGBS) is rare, with only 40 cases reported in the literature. Most of these have been diagnosed as leiomyosarcoma. We aimed to evaluate the histological features of a case series of this rare tumor and correlate these with clinical features. Design Cases recorded as “gallbladder sarcoma” from different institutes were reviewed and the clinicopathological features of these cases were recorded. Only primary gallbladder wall mesenchymal tumors were included. Epithelial tumors, mixed tumors (carcinosarcoma or sarcomatoid carcinoma), and tumors extending into the gallbladder from the abdomen or sarcoma with other known primaries were specifically excluded. Result PGBS occurred in one male and six females with a median age of 70 (range 64–82) years. Patients presented with acute or chronic cholecystitis, abdominal pain, weight loss, and pruritis. They were generally found to have elevated alkaline phosphatase and bilirubin, and leukocytosis. Tumors ranged from 1.1 to 4 cm with a median size of 3 cm. Most PGBS arose in the body but one arose in the fundus. All tumors were associated with ulcerated mucosa. Based on morphological and immunohistochemical features of the PGBS, there were three myxofibrosarcomas (malignant fibrous histiocytoma, MFH, storiform pleomorphic), one leiomyosarcoma (LMS), one angiosarcoma (AS), and two liposarcomas (LS). All patients received cholecystectomy and three received adjuvant chemotherapy. Follow-up revealed that six patients died of the disease 6 weeks to 2 years after diagnosis and one died of unrelated causes. Conclusion PGBS are rare and mainly occur in the gallbladder body in middle-aged females. They generally present with acute cholecystitis and have a very poor prognosis. A variety of sarcoma types are found with MFH being the predominant variant. E. A. Husain and R. J. Prescott contributed equally to this paper.     

代谢综合征与结直肠腺瘤的研究进展

近年许多研究表明代谢综合征与结直肠腺瘤关系密切。多项流行病学研究评估了肥胖、血糖异常、血脂异常和高血压等代谢综合征组分与结直肠腺瘤的风险。这种关系的潜在机制尚不清楚,胰岛素抵抗和慢性炎症是可能的影响因素。本文就代谢综合征与结直肠腺瘤的关系作一综述。     

胃肠道间质瘤临床病理免疫组化分析

目的通过检测原癌基因c-kit蛋白（CD117）在胃肠道间质瘤（GISTs）中的表达,探讨CD117在GISTs诊断中的意义。方法收集50例GISTs病例行常规检查及免疫组化染色。标记抗体主要为CD117、CD34 SMA、S100、desmin。结果50例中49例（98％）CD 117阳性,39例（78％）CD34阳性,4例（8％）SMA阳性,2例（4％）S100阳性。其中良性组CD117 12例（12／12）均阳性,交界性组CD117 7例（7／8）阳性。恶性组30例（30／30）CD 117阳性。对照组平滑肌瘤及神经鞘瘤CD117均阴性。结论CD117在GISIs的鉴别诊断中具有重要意义。     

Gallbladder Contractility in Liver Cirrhosis: Comparative Study in Patients with and Without Gallbladder Stones

An increased prevalence of gallstones was demonstrated in patients with liver cirhosis, higher in the advanced stages of the disease. Some studies have found impaired emptying of the gallbladder in cirrhotic patients. Our aim here was to investigate gallbladder emptying in cirrhotic patients with and without gallstones to find out whether emptying is further impaired in the presence of gallstones. The study group comprised 24 patients with liver cirrhosis and gallstones, 8 in each Child class. The controls were represented by 18 cirrhotic patients without gallstones, 6 in each Child class. Fasting gallbladder volume was calculated by ultrasound using the ellipsoid formula. Gallbladder emptying was evaluated for 90 min after ingestion of a solid-liquid meal (14 g fat, 425 kcal), by assessing minimal residual volume, gallbladder ejection fraction, and area under emptying curve at 15-min intervals. Statistical analysis was performed using the two-tailed Students' t test and Pearson's correlation coefficient. In controls, gallbladder fasting and residual volumes increased with the severity of cirrhosis, but gallbladder emptying did not change significantly. In cirrhotics with gallstones, gallbladder emptying decreased in Child C compared with Child A class patients and, also, compared to Child C controls. The number or size of gallstones, as well as the thickness of the gallbladder wall, did not correlate with gallbladder emptying parameters. Gallbladder contractility is impaired in patients with liver cirrhosis and gallstones. Hypomotility is proportional to the severity of liver disease. Gallbladder hypomotility might contribute to the increased gallstone formation in patients with advanced cirrhosis.     

糖尿病从肝胆论治初探

目的探讨糖尿病从肝胆论治的效果观察。方法选取2013年2月—2014年2月医院接受治疗的糖尿病患者84例,对照组患者采用常规治疗,观察组患者采用西医治疗手段进行治疗。结果观察组在治疗后,痊愈率和好转率明显比对照组高,将两组患者的总有效率进行对比,差异有统计学意义(P0.05)。结论对糖尿病从肝胆方面进行论治,能够取得良好的治疗效果,值得进一步推广研究。     

肝硬化患者胆囊和胃排空功能的研究

例肝硬化患者和10例健康对照者,禁食12小时后口服液体脂餐400ml,采用实时超声方法测定空腹及餐后90分钟内每15分钟胆囊及胃排空功能.结果显示:肝硬化患者胆囊最大排空率较对照组明显降低,胃半排空时间比对照组明显延长,提示肝硬化患者胆囊排空不足,胃排空延迟.肝硬化患者胃及胆囊排空曲线示胃排空延迟,胆囊再充盈迟缓.胆囊和胃排空曲线交点与对照组相似.提示肝硬化患者胆囊排空和胃排空可能有一定联系.结论:肝硬化患者存在胆囊和胃排空运动障碍,胆囊和胃排空之间可能存在一定联系.     

Correlation between Surrogate Quality Indicators for Adenoma Detection Rate and Adenoma Miss Rate in Qualified Colonoscopy,CORE Study: KASID Multicenter Study

Background/AimsThe adenoma detection rate (ADR) does not reflect the complete detection of every adenoma during colonoscopy; thus, many surrogate indicators have been suggested. This study investigated whether the ADR and surrogate quality indicators reflect the adenoma miss rate (AMR) when performing qualified colonoscopy.MethodsWe performed a prospective, multicenter, cross-sectional study of asymptomatic examinees aged 50 to 75 years who underwent back-to-back screening colonoscopies by eight endoscopists. The ADR and surrogate quality indicators, including polyp detection rate, total number of adenomas per colonoscopy, additional adenomas found after the first adenoma per colonoscopy (ADR-Plus), and total number of adenomas per positive participant, were calculated for the prediction of AMR.ResultsA total of 371 back-to-back colonoscopies were performed. There was a significant difference in ADRs (range, 44% to 75.4%; p=0.024), polyp detection rates (range, 56% to 86.9%; p=0.008) and adenomas per positive participants (range, 1.19 to 2.30; p=0.038), and a tendency of a difference in adenomas per colonoscopy (range, 0.62 to 1.31; p=0.051) and ADR-Plus (range, 0.13 to 0.70; p=0.054) among the endoscopists. The overall AMR was 20.1%, and AMRs were not different (range, 13.9 to 28.6; p>0.05) among the endoscopists. No quality indicators were significantly correlated with AMR. The number of adenomas found during the first colonoscopy was an independent factor for increased AMR (odds ratio, 1.79; p<0.001).ConclusionsThe colonoscopy quality indicators were significantly different among high-ADR endoscopists, and none of the quality indicators reflected the AMR of good quality colonoscopy performances. The only factor influencing AMR was the number of adenomas detected during colonoscopy.     

Immunohistochemical Study on Acetaldehyde Adducts in Alcohol-Fed Mice

Background: Acetaldehyde binds to some proteins, which results in Schiff base formation. It is assumed that acetaldehyde binds to the proteins after the consumption of ethanol, to form an adduct. Such acetaldehyde adducts are related to organ disease. Methods: We examined 8-week-old male BALB/c mice, which were given a liquid diet for 7 days. The diet consisted of vitamins, minerals, amino acids, and a 5% (v/v) ethanol solution. After the 7 days, we took tissue samples from the brain, liver, and adrenal cortex to investigate the distribution of acetaldehyde adducts. We performed immunohistochemical staining of the cerebral cortex, liver, and adrenal cortex from the mice by using antibodies against acetaldehyde adducts. Results: Our study showed that acetaldehyde adducts formed in the cerebral cortex in the early phase in alcohol-fed mice. Conclusions: Because acetaldehyde in the liver has been shown to cause liver damage, our study suggests a relationship between acetaldehyde adducts in the brain and brain damage.     

Gallbladder Contents and Fasting Gallbladder Volumes during and after Pregnancy

Background: A high risk of developing sludge or gallstones has been associated with pregnancy. The aim of this study was to relate the prevalence of sludge and gallstones during and shortly after pregnancy to fasting gallbladder volume as an indicator of gallbladder motility. Methods: The population included 114 apparently healthy pregnant women from the Outpatient Clinic of Obstetrics of a large regional hospital and from the practices of regional midwives. Ultrasonography of the gallbladder was performed at weeks 15, 25, and 35 of gestation and at week 3 and month 6 postpartum. Results: At gestational week 15, 3 women had gallstones and 10 had sludge (mean volume, 33.8 ml), and 99 women had a normal gallbladder (mean volume, 30.5 ml). At week 25, 1 woman with a normal gallbladder formed gallstones and underwent cholecystectomy shortly after, and 22 women had sludge, of whom 13 had a normal gallbladder at first examination (mean volume, 33.2 ml). In 88 women with normal gallbladders (of whom 2 had sludge at week 15) mean volume was 31.9 ml. At week 35, 2 women had gallstones, and 21 had sludge (mean volume, 30.5 ml). In the remaining 79 women the gallbladders were clear (mean volume, 29.5 ml). Eight women developed sludge and two women gallstones in normal gallbladders at week 25. Seven women with sludge at week 25 had a normal gallbladder at week 35. Three weeks postpartum only 10 of 100 women had sludge (mean volume, 29.1 ml). Of these 10, 9 women had a normal gallbladder at week 35. Twenty of 21 women with sludge at week 35 had normal gallbladders week 3 postpartum. Gallstones found at week 35 had disappeared. In the women with a normal gallbladder the mean volume was decreased to 19.7 ml (P &;lt; 0.0001). Six months postpartum, sludge was found in 6 (mean volume, 18.4 ml) of 93 women (mean volume, 20.3 ml), of whom 5 had a normal gallbladder at week 3 postpartum. Only 61 women showed a normal gallbladder at each examination of the study. No differences in patient characteristics were found between women with normal gallbladders and those with sludge or gallstones. Conclusions: Fasting gallbladder volume was increased in all pregnant women. This could not explain the formation of sludge or gallstones during gestation. Decrement of gallbladder volumes after delivery was faster in normal, clear gallbladders. More than a prerequisite, increased fasting gallbladder volume seemed to be a permissive factor of pregnancy-associated gallstone formation.     

rasP^21、GST—π在胃癌及癌前病变组织表达的研究

目的;观察rasP^21、GST－π在胃癌及癌前病变组织中的表达,探讨复合表达在胃粘膜癌变过程中的意义。方法：应用免疫组化（S－P）法测定40例肠上皮化生（不全结肠型）,76例异型增生（轻度20例,中度34例,重度22例）和42全癌组织中rasP^21、GST－π的表达及复合表达情况,以10例萎缩性胃炎胃粘膜做对照。结果：（1）rasP^21、GST－π在萎缩性胃炎中无阳性表达,在肠上皮化生、异型增生及胃癌中表达率及表达强度逐渐增高（P＜0．05或0．01）;在轻、中重度异型增生中表达率及表达强度逐渐增高（P＜0．05或0．01）;在重度异型增生中表达率有表达强度与胃癌无显著性差异（P均＞0．05）。（2）rasP^21、GST－π在肠上皮化生、异型增生及胃癌中复合表达率逐渐增高（P＜0．01）;在轻、中、重度异型增生中复合表达率逐渐增高（P＜0．05）;在重度异型增生与胃癌的复合表达率无显著差异（P＞0．05）。结论：rasP^21、GST－π均与胃粘膜癌变过程有关,联合检测对胃癌的早期诊断有重要意义。     

Immunohistochemical Study of Thrombolytic Mechanisms

The indirect immunofluorescent staining technic has been employed tostudy the localization onto fibrin clots of components of the fibrinolysinsystem and its activators. Immunodiffusion technics revealed the heterogeneity of the various enzyme preparations used. The activated fibrinolyticenzyme preparations were found to localize onto and diffuse into the matrixand core of the clots. High degree of localization was seen with streptokinase-,urokinase- and spontaneously activated human plasmin, as well as humanplasminogen. Chloroform-activated bovine plasmin localized to a lesser extent. No differences were observed in the results whether the fibrin clots wereof human, canine or bovine origin.

Submitted on December 18, 1963 Accepted on November 5, 1964