垂体催乳素瘤合并妊娠患者的管理

垂体催乳素瘤是最常见的功能性垂体腺瘤, 可导致育龄期女性出现月经紊乱及不孕症。经过多巴胺受体激动剂或手术等治疗可以恢复患者的排卵和生育能力。对于催乳素瘤合并妊娠患者的管理国内尚无统一规范。本文就有生育意愿的女性催乳素瘤患者的妊娠时机、妊娠期及产后管理进行相关讨论。     

催乳素分泌瘤的分子生物学研究进展

催乳素(prolactin,PRL)瘤是最常见的垂体前叶功能性腺瘤,通常认为其发病机制涉及调节因素的异常或垂体PRL分泌细胞本身的缺陷。     

高催乳素血症的诊断与治疗

介绍高催乳素血症的病因及发病机制,要注意由药物引起者。对催乳素瘤应首选药物治疗。另外,介绍了治疗高催乳素血症的新的药物。     

垂体催乳素瘤的病因及发病机理

本文综述了近年来对垂体泌乳素瘤病因及其发病机理的认识。目前主要有两种观点,一是认为病变在下丘脑,一是认为原发于垂体的功能自主性腺瘤。     

13例青少年起病的男性垂体催乳素瘤临床分析

目的探讨男性青少年催乳素瘤的临床特点、治疗与预后。方法回顾性分析13例青少年男性催乳素瘤患者临床表现及疗效。结果（1）男性青少年催乳素瘤以大腺瘤为主。头痛和第二性征发育障碍常见,但较少引起生长停滞。（2）溴隐亭治疗安全有效,与手术相比,可以保护垂体前叶功能,改善第二性征发育。结论男性青少年催乳素瘤采用溴隐亭治疗较手术更为可取,必要时,联合治疗有助于缓解病情。     

血清催乳素水平对垂体腺瘤诊断和治疗的意义

本文介绍261例垂体腺瘤、52例鞍部其他肿瘤、67例原因不明闭经妇女血清催乳素(PRL)测定结果。嫌色细胞瘤、肢端肥大症和鞍部其他肿瘤引起PRL升高者分别为56.5％、32.9％和34.6％。根据PRL升高程度作者认为超过5000mIU/L(200μg/L)者提示有PRL瘤。PRL瘤约占“嫌色细胞瘤”的1/3左右。PRL中度升高不能肯定是PRL瘤,要结合临床和蝶鞍X线检查考虑。PRL水平和PRL瘤大小呈正相关。原因不明闭经妇女20％伴有高PRL血症,PRL测定有助于早期诊断PRL瘤。     

神经生长因子对体外培养的垂体催乳素瘤细胞的抑制作用

目的 研究神经生长因子（ＮＧＦ）和溴陷亭（ＢＣ）对体外培养的垂体乳素（ＰＲＬ）分泌腺瘤细胞的激素分泌量和增殖的影响。方法 每例体外培养的垂体ＰＲＬ分泌腺瘤细胞分成４组;对照组、ＮＧＦ组、ＢＣ组和ＮＧＦ＋ＢＣ组,对不同的药物干预,观察培养液不激素分泌量和＾３Ｈ－胸腺啶脱氧核苷（ＴｄＲ）摄取率的改变。结果 在８例培养成活的垂体ＰＲＬ分泌腺瘤细胞中,与对照组相比,ＮＧＦ对ＰＲＬ分泌量的抑制作用不明显,但     

20例男性垂体催乳素瘤MRI特征分析并文献复习

目的 探讨男性垂体催乳素瘤的临床及MRI特征,提高其正确诊断率.方法 回顾性分析20例经手术病理或内分泌治疗有效证实的男性催乳素腺瘤.结果 在MRI诊断的20例男性催乳素瘤患者中,微腺瘤9例,大腺瘤11例.平扫T1WI呈稍低或等信号,T2WI均为稍高～高信号,常规增强均可见明显强化.侵袭性者均为大腺瘤,多伴有视交叉受侵或蝶窦、海绵窦侵犯,部分伴骨质破坏.结论 男性垂体催乳索瘤的临床与MRI表现均与女性不同,MRI对催乳素瘤诊断有重要价值,但应注意临床与影像两者结合,以达到早期、准确诊断.     

催乳素释放肽的研究进展

催乳素释放肽是新近发现的一种神经肽,它在下丘脑、延髓、外周组织中都有分布.研究显示它在调节催乳素和生长激素的释放、调节下丘脑-垂体-性腺轴、下丘脑-垂体-肾上腺轴及睡眠、摄食等方面具有广泛的作用.本文综述了催乳素释放肽的基因、结构、组织分布和生物学功能.     

肺癌脑转移252例综合治疗临床分析

目的　探讨肺癌脑转移综合治疗的疗效及预后影响因素。方法　回顾性分析了１９９０年１ 月～１９９６ 年１２ 月采用不同方法治疗的２５２ 例肺癌脑转移患者生存期与生存率。结果　转移灶手术切除及γ或 Ｘ刀治疗辅以放疗、化疗以及放疗与化疗联合组的中位生存期及１ 、２ 年生存率明显高于单纯放疗与化疗组（ Ｐ＜ ００１ 及 Ｐ＜ ００５） ,肺癌的病理类型对生存期与生存率无明显影响（ Ｐ＞００５） ;单发转移及无颅外转移者生存期（ 中位生存期分别为８５ 和８５ 个月） 与生存率（１ 年生存率分别为３５ ％ 和２９ ％ ,２ 年生存率分别为１１ ％ 和８ ％ ） 明显高于多发转移及伴颅外血行转移者（ Ｐ＜ ００１） ;高年龄者（ ≥５０ 岁）１ 年生存率（２９ ％ ） 明显高于低年龄组（１５ ％ , Ｐ＜ ００５） 。结论　转移灶的手术切除及γ或 Ｘ刀治疗加放疗和化疗是治疗肺癌脑转移患者的首选方法,转移的数量与部位多少及年龄是影响预后的因素。     

Management of prolactinomas

The management of prolactinomas requires a complex interaction of medical, surgical and radiotherapeutic intervention. With the judicious use of all these modalities, patients can usually be managed with great success and, perhaps more importantly, their presenting complaints (gonadal dysfunction and infertility) are usually completely corrected.     

Management of resistant prolactinomas

Resistance to dopamine agonists occurs in a subset of patients with prolactin-secreting pituitary tumors. The resistance is mediated by loss of pituitary D2 receptors and occurs in both microadenomas and macroadenomas. Cabergoline is the most effective dopamine agonist and tumors that do not respond to bromocriptine or quinagolide frequently respond to cabergoline. Treatment options include maximizing the dose of the dopamine agonist, changing agonists, trans-sphenoidal surgery and radiation therapy. The goal of therapy is to restore and maintain gonadal and neurologic function, and this might occur in the absence of a normal prolactin level or a significant change in tumor size. Trans-sphenoidal pituitary surgery should be reserved for patients who are intolerant of medical therapy, or in whom this has failed. Radiation therapy has a limited role in treatment of resistant prolactinomas and should be reserved for patients in whom medical and surgical therapy has failed.     

Effective Biliary Drainage and Proper Treatment Improve Outcomes of Hepatocellular Carcinoma with Obstructive Jaundice

Background/Aims

We investigated the treatment outcomes and prognostic factors of hepatocellular carcinoma (HCC) with obstructive jaundice.

Methods

Among 2,861 patients newly diagnosed with HCC between 2002 and 2011, a total of 63 patients who initially presented with obstructive jaundice were analyzed. Only four patients presented with resectable tumors and underwent curative resection. In the other patients who presented with unresectable tumors, 5, 8, 9, and 18 patients received transarterial chemoembolization (TACE), chemotherapy, radiotherapy, and combined treatment, respectively. Both the clinical and the treatment factors that affect overall survival (OS) were analyzed.

Results

The median OS was 4 months, and the 1-year OS rate was 23%. Patients who received treatment for HCC had a significantly improved OS rate compared with the patients who received supportive care only (1-year OS, 32% vs 0%; p<0.01). Responders to treatment showed a better OS than nonresponders (1-year OS, 52% vs 0%; p<0.01). TACE and radiotherapy resulted in relatively good treatment responses of 64% and 67%, respectively. In multivariate analyses, treatment of HCC (p=0.02) and the normalization of serum bilirubin by biliary drainage (p=0.02) were significantly favorable prognostic factors that affected the OS.

Conclusions

Unresectable HCC with obstructive jaundice has a poor prognosis. However, effective biliary drainage and treatment of HCC such as with TACE or radiotherapy improves survival.     

小细胞肺癌术前化疗的临床和病理学观察

目的观察小细胞肺癌(SCLC)术前化疗对临床、病理学影响。方法32例SCLC术前化疗2个疗程,用EP方案(VP 16100m g/天,DDP 80m g/天),5天为1个疗程。化疗结束后20-30天手术,切除标本送病理学检查。结果手术切除率100%。术中见肿瘤附近纤维组织增生,肿大淋巴结包膜坚韧。病理学检查发现肿瘤消失、由纤维组织取代6例(18.7%);镜下少量癌组织残留5例(15.6%);少量生长活跃的癌组织13例(40.6%);癌组织轻度变性坏死或无明显改变8例(25.0%)。病理分期较临床分期提前,有利于手术切除。结论作为SCLC的综合治疗方法,术前化疗值得推荐。     

胰岛素瘤17例临床诊治分析

目的　探讨胰岛素瘤的诊断和治疗方法。　方法　回顾性地分析我院自 196 6年 ～ 2 0 0 0年收治的 17例胰岛素瘤。　结果　胰腺 B超、腹部 CT、选择性腹腔动脉造影检查准确率分别为 82 .4 %、72 .7%、6 0 %。2例未手术 ,15例肿瘤切除。肿瘤位于胰头钩突 3例 ,胰颈 1例 ,胰体尾 11例 ;80 %肿瘤直径 <3cm;行单纯肿瘤摘除术 8例 ,胰体尾切除术 4例 ,胰体尾加脾脏切除者 2例 ,胰腺节段性切除(捆绑式胰体尾空肠吻合空肠端侧吻合术 ) 1例。　结论　血糖、血胰岛素水平测定结合胰腺 B超、CT检查能有效提高功能性胰岛素瘤的诊断。治疗多为单纯性肿瘤切除 ,恶性肿瘤应行根治性切除 ,腹腔镜微创手术正处于尝试阶段 ,药物治疗仍然在探讨阶段。     

Management of aggressive pituitary adenomas: current treatment strategies

Aggressive pituitary adenomas are notoriously difficult to manage due to their size, invasiveness, speed of growth and high frequency of recurrence. Except for prolactinomas, surgery (usually transsphenoidal but sometimes transcranial) is the first-line option, but re-growth of aggressive tumors is almost inevitable and monitoring and repeat surgery is required to control symptoms. In prolactinomas, dopamine agonists are the first-line treatment and they normalize prolactin levels in most patients even with macroprolactinomas. Somatostatin analogues offer another pharmacotherapy for pituitary adenomas either for primary therapy, pre-operatively to reduce the tumor volume and make it more amenable to surgical removal, or post-surgery to control re-expansion. When surgery and pharmacotherapy fail, radiotherapy is a useful third-line strategy that reduces recurrence, while extreme pituitary adenomas with metastases may potentially be managed with chemotherapy (although more data are needed). A combination of these therapies will be required for aggressive pituitary adenomas and careful follow-up is essential.     

Management of perianal fistulas in Crohn’s disease:An upto-date review

Perianal disease is one of the most disabling manifestations of Crohn’s disease.A multidisciplinary approach of gastroenterologist,colorectal surgeon and radiologist is necessary for its management.A correct diagnosis,based on endoscopy,magnetic resonance imaging,endoanal ultrasound and examination under anesthesia,is crucial for perianal fistula treatment.Available medical and surgical therapies are discussedin this review,including new local treatment modalities that are under investigation.     

A phase I/II study of nedaplatin and 5-fluorouracil with concurrent radiotherapy in patients with T4 esophageal cancer: Japan Clinical Oncology Group trial (JCOG 9908)

Background Nedaplatin is an analogue of cisplatin with less nonhematologic toxicity. The combination of nedaplatin and 5-fluorouracil showed a promising response rate in a previous phase II study for metastatic esophageal cancer. The purpose of this study was to determine a recommended dose and to evaluate the efficacy of nedaplatin and 5-fluorouracil combined with concurrent radiotherapy.Methods Eligibility criteria included squamous cell carcinoma of the thoracic esophagus; T4 disease without distant organ metastasis; age 20–70 years; performance status 0–2; and adequate organ functions. Patients received two cycles of nedaplatin (80 mg/m² or 90 mg/m²) on day 1 and continuous infusion of 5-fluorouracil 800 mg/m²/day on days 1–5, every 5 weeks with concurrent radiotherapy 60 Gy in 30 fractions.Results Between December 1999 and April 2002, 26 patients were accrued. The recommended dose of nedaplatin was 90 mg/m². Common grade ≥3 toxicities included leukopenia 9, neutropenia 5, thrombocytopenia 4, esophagitis 4, and esophageal fistula 3. Three of 26 patients achieved complete response (12%; 95% confidence interval, 2%–30%). With a minimum follow-up of 26 months for surviving patients, the median survival time was 12 months (95% confidence interval, 9–22 months), and the 2-year overall survival was 31% (95% confidence interval, 13%–49%).Conclusions This combined therapy is active with acceptable toxicity, however, the survival figure remains poor. Further investigation into more effective treatment is needed.     

Management of cystic prolactinomas: a review

Introduction

Cystic prolactinoma is a variant of prolactin-secreting pituitary adenoma. The strategies for the management of cystic prolactinoma have not been addressed thoroughly in clinical guidelines.

Methods

A literature search was performed using Pubmed to review the current approaches to the treatment of cystic prolactinoma.

Results

Transsphenoidal resection is an effective and relatively safe approach for the treatment of cystic prolactinoma, however, morbidity of surgery is dependent on the skill of the surgeon. Emerging studies allude to the efficacy and safety of dopamine agonists in the management of cystic prolactinoma. Dopamine agonists are associated with considerable rates of clinical improvement and tumor shrinkage, hence reducing the need for surgical intervention.

Conclusions

Recent studies suggest that dopamine agonist therapy may be an effective and safe treatment option in a considerable portion of patients with cystic prolactinomas. We suggest that dopamine agonists should be considered as a first-line therapy for cystic prolactinoma in the absence of indications for early surgical intervention.