72例新月体肾炎的临床分析

本文分析经肾活检确诊的７２例新月体肾炎，占全部肾活检的１．３７％，按免疫病理分型，Ⅰ型９例（１２．５％），Ⅱ型４８例（６６．７％），Ⅲ型１５例（２０．８％），原发病因以狼疮性肾炎最多见（２５例），急进性肾炎次之（１８例），血管炎居第三（１０例），在贫血，高血压及肾功能损害程度上Ⅰ型重于Ⅱ型和Ⅲ型，而大量蛋白尿，肉眼血尿Ⅲ型多于Ⅰ和Ⅱ型，Ⅲ型新月体肾炎中ＡＮＣＡ，ＭＰＯ－ＡＮＣＡ，ＡＥＣＡ阳性率分别     

肺大细胞癌的临床与病理分析

目的探讨肺大细胞癌临床特点和病理分型。方法对１９７８～１９９７年手术切除的５４例肺大细胞癌的病理资料与临床资料进行了分析。结果５４例大细胞癌中有透明细胞癌６例,巨细胞癌１例。男女之比为５∶１（４５／９）,男性明显多于女性;肺大细胞癌占肺癌切除病例的１２８％;平均存活时间为２３个月,Ｐ５３蛋白过度表达,阳性率为６５％（１３／２０）,介于鳞癌、腺癌与小细胞癌之间,增殖细胞核抗原（ＰＣＮＡ）免疫组化染色阳性率为１００％（２０／２０）。结论肺大细胞癌作为一种病理类型,已不利于临床的诊断及治疗,建议将肺大细胞癌分成鳞分化型、腺分化型、神经内分泌型、未分化型。     

bcl—2蛋白在肝肿瘤组织的表达及意义

目的 探讨抗凋亡基因ｂｃｌ－２蛋白在常见肝肿瘤发生中的作用。方法 应用ｂｃｌ－２癌蛋白单克隆抗体对６４例四种类型的肝恶性肿瘤进行ＬＳＡＢ免疫组织化学标记。结果 １６．２％（６／３７）的肝细胞癌，６９．２％（９／１３）的胆管细胞癌，２０．０％（１／５）的肝母细胞瘤和２２．２％（２／９）肝转移癌呈ｂｃｌ－２癌蛋白阳性表达，其中胆管细胞癌的阳性率显著高于其癌旁组织（Ｐ值〈０．０５）和肝细胞癌（Ｐ值〈０．     

nm23—H1与CD44V6在非小细胞肺癌中的表达及临床意义

目的 通过检测ｎｍ２３－Ｈ１与ＣＤ４４Ｖ６在ＮＳＣＬＣ中的表达,探讨抑癌基因与转移相关基因在ＮＳＣＬＣ中的表达及临床意义。方法 采用免疫组化法检测１４７例ＮＳＣＬＣ ｎｍ２３－Ｈ１、ＣＤ４４Ｖ６的表达情况。结果 ｎｍ２３－Ｈ１阳性９２例（６２．６％）。Ⅰ、Ⅱ期阳性率６５．３％（６２／９５）,Ⅲ、Ⅳ期为５７．７％（３０／５２）,两组比较ｘ＾２＝０．２０。Ｐ〉０．０５。高、中分化组阳性８３例（６８．６％）,与低分化组阳性（３４．６％）比较ｘ＾２＝１０．５５,Ｐ〈０．０１。腺癌中ｎｍ２３－Ｈ１阳性５２例（７８．８％）,鳞癌中阳性３２例（５０．８％）,两类型肺癌比较ｘ＾２＝１１．１２,Ｐ〈０．０１。ＣＤ４４Ｖ６阳性率６４．６％（９５／１４７）。在Ⅰ、Ⅱ期中阳性表达率６６．３％（６３／９５）,Ⅲ、Ⅳ期阳性表达５９．６％（     

33例早期胃癌的TNM分期分析

我院自１９９４年１月至１９９９年６月期间,经胃镜检查并手术后病理检查确诊早期胃癌３３例,现将其手术后病理检查的ＴＮＭ分期情况作一回顾性分析。 一、胃镜检查：根据１９６２年日本内镜学会提出分型的标准,本组３３例早期胃癌中Ｉ型３例（９．０％）;Ⅱ型１５例（４５．５％）,Ⅱ型中Ⅱａ型５例、Ⅱｂ型３例、Ⅱｃ型６例、Ⅱａ＋Ⅱｃ型１例;Ⅲ型１５例（４５．５％）。早期胃癌部位,胃窦１８例（５４．５％）,胃角 ７例（２１．２％）,胃体６例（１８．２％）,贲门２例（６．１％）． 二、手术所见：３３例病人手术前均常规…     

影响小肝癌预后的临床病理因素分析

分析４０例手术切除小肝癌的临床病理学特征，其中３２例随访１－１８年（中位数９年）１，３，５，１０年生存率，≤５ｃｍ（１８例）为８８．９％，４４．４％，２２．２％及５．６％，≤３ｃｍ（９例）为１００％，６６．７％，３３．３％及２２．２％，≤２ｃｍ（５例）为８０．０％，４０．０％，４０．０％及２０．０％，总体生存率为９０．０％，５６．３％，２８．１％及１２．５％，１，３，５年复发率为：≤５ｃｍ为２２．     

bcl－2蛋白在肝肿瘤组织的表达及意义

探讨抗凋亡基因ｂｃｌ－２蛋白在常见肝肿瘤发生中的作用。方法应用ｂｃｌ－２癌蛋白单克隆抗体对６４例四种类型的肝恶性肿瘤进行ＬＳＡＢ免疫组织化学标记。结果１６．２％（６／３７）的肝细胞癌，６９．２％（９／１３）的胆管细胞癌，２０．０％（１／５）的肝母细胞瘤和２２．２％（２／９）的肝转移癌呈ｂｃｌ－２癌蛋白阳性表达，其中胆管细胞癌的阳性率显著高于其癌旁组织（Ｐ值＜０．０５）和肝细胞癌（Ｐ值＜０．０１）。癌旁组织中的阳性细胞主要为增生的小胆管上皮细胞，而在肝细胞不典型增生中阳性率颇低（１５．４％，２／１３）。结论ｂｃｌ－２基因可能在胆管细胞癌的发生中起重要作用，而不参与肝细胞的分裂、增殖。     

胃粘膜中增殖细胞核抗原及p53、K-ras、bc1-2基因蛋白的表达

为了解胃粘膜癌变过程中多基因蛋白的表达及意义，应用免疫组化技术检测１０７例内镜活检胃粘膜组织中增殖细胞核抗原（ＰＣＮＡ）及ｐ５３、Ｋ－ｒａｓ、ｂｃ１－２基因蛋白。结果各基因蛋白阳性率随病变程度加重而增加。Ⅲ型肠化生者增殖细胞核抗原标记指数（ＰＣＮＡＬＩ）及Ｋ－ｒａｓ、ｂｃ１－２基因蛋白阳性率较之Ⅰ、Ⅱ型肠化亦有增高趋势但未见统计学差异（Ｐ≥０．０５）。１２例Ⅲ型肠化中有９例出现Ｋ－ｒａｓ或ｂｃ１－２蛋白异常表达（７５．０％），显著高于Ⅰ、Ⅱ型肠化（２３．８％）（Ｐ＜０．０５）。在肠型及胃型胃癌ｐ５３表达率为５３．３％、３７．０％（Ｐ＞０．０５）；Ｋ－ｒａｓ为４０．０％、７．４％（Ｐ＜０．０５）；ｂｃ１－２为９３．３％、５９．３％（Ｐ＜０．０５）。１５例肠型胃癌中有９例同时存在２种或２种以上蛋白异常表达（３例ｐ５３与ｂｃ１－２表达异常，２例ｂｃ１－２与Ｋ－ｒａｓ表达异常，４例ｐ５３与ｂｃ１－２、Ｋ－ｒａｓ异常表达），高于胃型胃癌（Ｐ＜０．０５）。结果提示以上基因产物的表达异常与胃粘膜癌变相关，Ⅲ型肠化属于胃癌癌前病变范畴，肠型胃癌发生发展的分子机制与胃型胃癌显著不同。     

血脂康对Ⅱ型糖尿病糖、脂代谢的影响

目的验证血脂康对Ⅱ型糖尿病患者糖、脂代谢的影响。方法１００例Ⅱ型糖尿病在原降糖措施的基础上分为四组，不合并（Ａ组）和合并（Ｂ组）高脂血症各３０例加服血脂康，不合并（Ｃ组）和合并（Ｄ组）高脂血症各２０例不服血脂康为对照组，疗程２个月。结果Ａ、Ｂ两组分别降低空腹血糖７６％±７７％和１０８％±９６％，餐后２小时血糖１４１％±９０％和１２２％±１０５％，糖化血红蛋白Ａ１ｃ１１．０％±５．４％和６３％±７８％，总胆固醇９．０％±９．０％和１５．０％±９．０％，甘油三酯４．０％±１３．０％和２１．０％±２６．０％，与治疗前相比，差异有非常显著性（Ｐ值分别＜０．０５和＜０．０１），Ｃ、Ｄ组在观察前后各项指标无明显变化（Ｐ值均＞０．０５）。未见副作用。结论血脂康对Ⅱ型糖尿病除可调节异常血脂外，尚有一定降低血糖的作用。     

术后残胃病变633例临床分析

术后残胃作为一种特殊的癌前状态，已越来越引起人们的重视。我院自１９７９年５月至１９９９年６月对胃大部切除术后患者６３３例进行了胃镜检查，现将结果报告分析如下。１．一般资料：本组６３３例残胃病变中，男５５０例，女８３例，男女之比为６．６：１；年龄１９～８３岁，平均４７．８岁。胃镜检查距手术时间３个月～３０年。手术方式：ＢｉｌｌｒｏｔｈⅠ（ＢⅠ）式３３０例（５２．１％），ＢｉｌｌｒｏｔｈⅡ（ＢⅡ）式３０３例（４７．９％）。主要症状有上腹痛（６３．５％）、腹胀（５８．９％）、纳差（１６．６％）、黑便（…     

Factors affecting the yield of percutaneous cholangioscopic biopsy in patients with bile duct cancer

Background: This study analyzed the factors associated with the yield of percutaneous transhepatic cholangioscopic biopsies in patients with bile duct cancer. Methods: One‐hundred‐and‐sixteen patients who had received percutaneous transhepatic cholangioscopy and who had been confirmed as having bile duct cancer were enrolled in this study. Multiple targeted biopsies were taken under direct cholangioscopic view. Results: When the location of the tumor was divided into intrahepatic duct (IHD), hilar duct and common bile duct (CBD), the biopsy yield was significantly higher in IHD cancer (93.7%) than in cases of hilar cancer (69.6%) (P < 0.05). After a bile duct cancer had been classified as a nodular type (n = 31), papillary type (n = 27) or infiltrative type (n = 58) cancer upon cholangioscopic findings, the biopsy yields from nodular (96.8%) or papillary types (96.3%) were significantly higher than from infiltrative types (58.6%; P < 0.01). The positive rate for malignant cells was not influenced by the presence of tumor vessels or the number of biopsy samples taken. However, the sensitivity of the combination of cholangioscopic biopsy and tumor vessel in overall bile duct cancer, especially in the infiltrative type, was significantly increased when it was compared with that of cholangioscopic biopsies (P < 0.01) or tumor vessels alone (P < 0.01). Conclusions: Cholangioscopic biopsy provides a high positive yield of malignant cells in those patients with IHD, nodular‐type and papillary‐type cancers. The cholangioscopic classification of bile duct tumors might thus provide important clues to predict biopsy yield.     

胃肠道原发恶性淋巴瘤的内镜诊断探讨

本文报告经手术及病理检查证实的胃肠道原发恶性淋巴瘤２０例，对其中１３例行内镜检查者作了较细致观察与记录。肿瘤形态呈隆起型４例，溃疡型５例，局部浸润型１例，弥漫型３例。内镜确诊率为１５．４％，确诊加疑诊率为５３．８％。文中重点讨论了本病胃镜、肠镜的表现特点及活检取材的方法，提出了早期诊断的必要性和可能性。     

A Detailed Survey of Superficial Esophageal Cancer with Histological Features Other than Squamous Cell Carcinoma in Japan

Abstract: A questionnaire-based survey of cases of superficial esophageal cancer with histological features other than squamous cell carcinoma (SCC) was conducted prior to The 37th Conference of the Japanese Research Society for Early Esophageal Cancer and Chromoendoscopy. The data of cases resected between 1986 and 1996 at 25 Japanese institutions were evaluated. Among 2,381 cases of superficial esophageal cancer, 93 patients (3.9%) were diagnosed with histological features other than SCC. These included 6 cases of mucosal cancer and 87 cases of submucosal cancer, and were referred to as superficial nonsquamous cell carcinoma (NSCC). Most cases were grossly classified as O-I type. Elevated tumors, which included O-I and O-lla types, accounted for 80% of all lesions. Many cases of adenoid cystic carcinoma (ACC), adenosquamous carcinoma (ASC), basaloid carcinoma (BSC) and undifferentiated carcinoma (UND) were classified as O-lpl or O-lsep types. Almost all cases of carcinosarcoma (CASA) and malignant melanoma (MM) were classified as O-lp type. A small number of O-llc type tumors were observed and diagnosed as adenocarcinoma (AC), ACC ASC and BSC. All cases of AC were classified as unilocular tumor, and many cases were observed at the abdominal esophagus. However, the superficial esophageal tumors could not be differentiated by endoscopic features. The frequency of lymph node metastasis was slightly higher in UND and MM (60%), while the other histological types of esophageal cancer had an equivalent frequency to SCC (20–40%). Although the frequency of tumor recurrence was usually approximately 20%, the frequency of recurrent UND and MM was as high as 50–60%. Distant organ metastasis was the most commonly observed pattern of tumor metastasis. The five-year survival rate was approximately 60%, and there were no significant differences in the survival rate among the patients. However, the prognosis of UND and MM tended to be poor. (Dig Endosc 1999; 11: 12–23)     

Is the Histogenesis of 6-10 mm Early Colorectal Cancer Different from that of Larger Cancers?

Abstract: Out of a total of 466 cases of early colorectal cancer, we analyzed 139 cases with submucosal invasion (sm cancer) according to tumor size, gross appearance, depth and degree of invasion, and the presence of adenoma components. Early colorectal cancers 11 -20 mm in diameter were the most common lesion in this group, and the percentage with sm cancer increased with tumor size. More than 70% of relatively small sm cancers, 6-10 mm in diameter, had moderate or massive submucosal invasion similar to that found in large sm cancers. Only 35% of 6-10 mm cancers had an adenoma component; the majority (65%) had no adenoma component. In marked contrast, 63% of sm cancers 11 -20 mm in diameter had an adenoma component and in sm cancer the percentage of tumors composed solely of cancerous tissue without an adenoma component was low. Similar results were obtained when only protruding type sm cancers, which accounted for the majority of sm cancer cases, were included in the analysis. Therefore, we believe that the protruding type sm cancer 6-10 mm in diameter is at a stage close to advanced cancer. It is possible that many 6-10 mm sm cancers have a histogenesis different from that of large sm cancers.     

Value of biopsy and brush cytology in the diagnosis of gastric cancer. Shanghai Gastrointestinal Endoscopy Cooperative Group, People's Republic of China.

This report presents the diagnostic value of brush cytology in gastric cancer. Gastric biopsies and brush cytology were performed in 155 patients with gastric cancer and 48 with benign gastric disease. The positive rate for biopsy and brush cytology in cancer patients (including 11 cases of early gastric cancer) was 74.2% and 76.8% respectively. The positive rate of biopsy with concomitant brush cytology was 87.7, which was superior to that of biopsy or brush cytology alone (p less than 0.01). In 29 cases of gastric cancer involving the cardiac region. 20 were biopsy positive (69%) and 22 were brush cytology positive (75.9%). Biopsy with brush cytology was positive in 27 cases (93.1%) and gave better results than biopsy alone (p less than 0.01). The positive rate of biopsy with concomitant brush cytology in Borrmann type I, II, and III lesions (89.7%) was significantly higher than in Borrmann type IV lesions (50%). In the 48 patients with benign gastric lesion, biopsy and brush cytology each provided two false positives. The study shows that the combination of biopsy and brush cytology increases diagnostic accuracy for gastric cancer.     

Factors associated with pN3 stage tumors according to the TNM classification in advanced gastric cancer

BACKGROUND/AIMS: The aim of the present study was to analyze factors associated with pN3-stage tumors, as classified according to the TNM Classification of Malignant Tumors, in patients who undergo curative resection for advanced gastric cancer. METHODOLOGY: A total of 391 patients with advanced gastric cancer (247 males and 144 females; average age, 59.2 years) were enrolled in the present study. The numbers of dissected regional lymph nodes and positive nodes were assessed, and node stage was determined according to TNM. Patient survival and factors associated with pN3-stage tumors were then analyzed. RESULTS: The 5-year survival rate was 82.9% for the 132 N0 patients, 66.4% for the 154 N1 patients, 41.1% for the 64 N2 patients and 21.1% for the 41 N3 patients. A significant difference was found between some of the curves (N0 and N1, p = 0.0012; N1 and N2, p = 0.0007; N2 and N3, p = 0.0055). In logistic regression analysis, independent factors associated with advanced gastric cancers with a pN3-stage tumor were tumor diameter (> 6 cm vs. < or = 6 cm, p = 0.0037), number of dissected nodes (> 30 vs. < or = 30, p = 0.0143), depth of invasion (T3 or T4 vs. T2, p = 0.0028) and microscopic type (undifferentiated vs. differentiated, p = 0.0147). CONCLUSIONS: The results of the present study suggest that tumor diameter (> 6 cm), depth of invasion (T3 or T4) and microscopic type (undifferentiated type) are the most reliable indicators of pN3-stage tumors in patients who undergo curative resection for advanced gastric cancer.     

Significance of post-chemoradiation biopsy in predicting residual esophageal carcinoma in the surgical specimen

Pathologic complete response in the resected esophagus can be achieved in approximately 30% of patients with locally advanced esophageal or gastroesophageal junction carcinoma after preoperative chemoradiation therapy. These patients tend to have a longer survival than those who have less than pathologic complete response. Post-chemoradiation esophageal biopsy (PCEB) is used to check for the presence of residual tumor before a definitive resection is performed, but the clinical significance of PCEB findings is not clear due to the possibility of sampling bias and the superficial nature of the specimen obtained. We evaluated the use of PCEB (defined as biopsy taken within 30 days before esophagectomy) in predicting residual cancer in post-treatment esophagectomy specimens. PCEB was performed in 65 of 183 (36%) patients with locally advanced esophageal or gastroesophageal junction carcinoma, who received preoperative chemoradiation therapy. The cancer status in PCEB was correlated with the residual cancer in the esophagectomy specimens. PCEB had no cancer in 80% (52 of 65) of patients (Bx-negative) and cancer in 20% (13 of 65) of patients (Bx-positive). There was no difference in the presence of residual cancer (either in esophagus or lymph node) in esophagectomy specimens between Bx-negative patients (77%, 40 of 52) or Bx-positive patients (92%, 12 of 13), P = 0.44. The positive predictive value of biopsy was 92% (12 of 13), negative predictive value 23% (12 of 52), sensitivity 23% (12 of 52) and specificity 92% (12 of 13). There was no difference in the residual cancer staging in the esophagectomy specimen between Bx-positive and Bx-negative patients. In contrast, residual metastatic carcinoma in lymph nodes was more frequent in Bx-positive patients (69.2%, 9 of 13) than in Bx-negative patients (28.8%, 15 of 52), P = 0.01. Our data suggest that PCEB is a specific but not a sensitive predictor of residual cancer following esophagectomy. Bx-positive patients tend to have more frequent residual tumor in lymph nodes. The utility of PCEB in predicting residual cancer in the lymph nodes needs to be explored further along with molecular predictors of response to preoperative therapy.     

原发性大肠恶性淋巴瘤临床、内镜与病理特点

目的 搪塞原发性大肠恶性淋巴瘤（ＰＣＭＬ）的临床表现、内镜和病理特点。方法 采用血常规及血型检测，Ｘ线检查、内镜检查，最终均得到手术和病理证实。结果 ２４例ＰＣＭＬ中临床表现以腹痛、体重下降、发热、腹块、便血和大便习惯改变为主。病变位迂回在盲部９例（３７．５％），直肠１例（４．２％）。内镜下表现为隆起９／１６例（５６．２％）、浸润型４／１６型（２５．０％），溃疡型３／１６例（１８．８％），与术后分     

Dye Spraying and Magnifying Endoscopy for Dysplasia and Cancer Surveillance in Ulcerative Colitis

PURPOSE The aim of this study was to investigate detection of dysplasia or colitic cancer with ulcerative colitis by use of magnifying endoscopic observation.METHODS From 1986 through 2000, ulcerative colitis was diagnosed and treated in 886 patients at Kitasato University East Hospital. Of the total, we studied 25 patients in depth: 14 who had dysplasia alone, 5 in whom cancer was diagnosed during follow-up after the detection of dysplasia, and 6 who had colitic cancer.RESULTS Dysplasia was detected in 11 (3.2 percent) of 345 patients with extensive colitis and in 8 (3.7 percent) of 217 with left-sided colitis. Colorectal cancer was diagnosed in nine patients (2.6 percent) with extensive colitis and in two (0.9 percent) with left-sided colitis. Neither dysplasia nor colitic cancer was found in patients with proctitis-type colitis. Endoscopically, dysplasia and early cancer were characterized by granular or nodular protruding mucosa or by lowly protruding or flat mucosa, often associated with redness. Dye-spraying endoscopy was useful for detection. Magnifying endoscopy of ten regions of dysplasia (7 patients) and five early cancers (4 patients) showed IIIS to IIIL type pits or IV type pits. Biopsy of sites showing tumorous pits on magnifying endoscopy revealed dysplasia and early cancer. Observation of the pit pattern was found to be diagnostically useful.CONCLUSIONS Dye spraying and magnifying endoscopy are useful for the detection, targeted biopsy, and diagnosis of dysplasia and colitic cancer in patients with ulcerative colitis.     

Congenital expression of mdr-1 gene in tissues of carcinoma and its relation with pathomorphology and prognosis

ＮＴＲＯＤＵＣＴＩＯＮＭｕｌｔｉｄｒｕｇｒｅｓｉｓｔａｎｃｅ（ＭＤＲ）ｏｆｍａｌｉｇｎａｎｔｔｕｍｏｒｃｅｌｈａｓａｒｏｕｓｅｄｗｉｄｅｓｐｒｅａｄｉｎｔｅｒｅｓｔ．ＩｔｈａｓｂｅｅｎｓｈｏｗｎｔｈａｔＭＤＲｉｓｐｒｅｓｅｎｔｉｎｍａｎｙｍａｌｉｇｎ...