超声造影时间-强度曲线在评价原发性肝癌微波消融术疗效中的作用

目的探讨超声造影时间-强度曲线在评价原发性肝癌微波消融术疗效中的作用。方法65例原发性肝癌共103个病灶采用微波消融治疗,对消融灶超声造影与增强MRI检查结果进行比较。结果治疗前,超声造影时间-强度曲线发现恶性肿瘤结节103个,增强MRI发现101个,两者差异无统计学意义(P>0.05)。治疗后,超声造影对完全消融病灶表现为肿瘤血流灌注消失,未见造影剂填充,超声造影时间-强度曲线表现为无增强,参数峰值强度(IMAX)、上升时间(RT)、达峰时间(TTP)≈0,与增强MRI相符,较好地反映了消融灶大小;而对不完全消融,其造影时相增强,时间-强度曲线明显强化,其IMAX、RT、TTP与正常组织比较,差异有统计学意义(P<0.05),与增强MRI相符,可见病灶区"快进快出"血流灌注,但增强MRI未见异常。超声造影判定微波消融术疗效的灵敏度和准确率分别为97.8%和94.2%。结论超声造影时间-强度曲线可直观、动态反映原发性肝癌微波消融术治疗前后血流灌注,在评价治疗效果中有较大的临床应用价值。     

经阴道彩色多普勒超声病灶内微血管与早期宫颈癌预后发展的关系

目的 探讨经阴道彩色多普勒超声病灶内微血管情况与早期宫颈癌的预后情况的关系,给予早期宫颈癌的诊疗及预后评估提供参考依据.方法 收集80例宫颈浸润癌患者的完整临床资料,采用统计学方法分析经阴道彩色多普勒超声早期宫颈癌病灶内血管生成、血流参数情况与其经手术治疗后的临床预后指标及病理特征的相关性.结果 宫颈癌病灶内微血管血流丰富与临床Ⅱ期、间质浸润≥10.0 mm、脉管受累、肿瘤直径≥15.0 mm、宫旁浸润≥10.0 mm、淋巴结转移相关(P<0.05);PI及RI与间质浸润深度、有无转移存在相关性(P<0.05),不同血流情况组术前超声早期宫颈癌病灶微血管情况(PI、RI、血流情况)比较差异有统计学意义(P<0.05),丰富血流组的PI、RI明显低于血流不丰富及血流不明显组(P<0.05).不同预后风险组术前超声早期宫颈癌病灶微血管情况(PI、RI、血流情况)比较差异有统计学意义(P<0.05),高风险组的PI、RI明显低于中、低风险组,血流也比低风险组更加丰富(P<0.05).结论 经阴道彩色多普勒超声病灶内微血管情况与早期宫颈癌的预后发展存在相关性,宫颈癌灶内血流情况及血流动力学参数可用于预测早期宫颈癌的预后.     

甲状腺腺瘤和结节性甲状腺肿Ang-1的表达及其与超声造影定量参数的关系

目的:研究甲状腺腺瘤和结节性甲状腺肿中血管生成素-1(angiopoietin-1,Ang-1)的表达情况,并探讨其与超声造影的相关性.方法:回顾性分析40例甲状腺腺瘤和40例结节性甲状腺肿患者的超声造影检查结果,根据时间强度曲线获得造影参数.术后标本用Western blot方法检测其Ang-1表达情况,并与超声造影指标进行相关性分析.结果:40例甲状腺腺瘤36例造影后肿块与周围甲状腺表现为高增强,4例为等增强.其中34例肿块内部增强均匀.40例结节性甲状腺肿患者中30例造影后结节与周围甲状腺实质等增强,6例出现高增强,4例为低增强,其中14例患者肿块内部回声不均匀.甲状腺腺瘤组mTT、IMAX 大于结节性甲状腺肿组(P<0.05);甲状腺腺瘤较结节性甲状腺肿Ang-1表达明显升高(P<0.01).Ang-1表达水平与RT、TTP、mTT呈负相关(P<0.05),与IMAX呈正相关(P<0.05).结论:Ang-1在甲状腺腺瘤中的表达水平高于结节性甲状腺肿,并与超声造影指标存在相关性,超声造影可为二者的诊断及预后提供依据.     

经阴道彩色多普勒超声检查病灶内微血管情况与早期宫颈癌患者临床特征及预后的关系

目的 探讨经阴道彩色多普勒超声检查病灶内微血管情况与早期宫颈癌患者临床特征及预后的关系.方法 选择进行经阴道彩色多普勒超声检查的76例早期宫颈癌患者和80例慢性宫颈炎患者,分别作为观察组和对照组.比较两组患者的微血管情况[阻力指数(RI)、搏动指数(PI)、血流情况],分析病灶内微血管情况与早期宫颈癌患者临床特征的关系,比较不同血流情况早期宫颈癌患者的RI、PI.对早期宫颈癌患者进行2年随访,采用Logistic回归模型分析早期宫颈癌患者预后的影响因素.结果 观察组患者的RI、PI均明显低于对照组,微血管内的血流丰富程度明显高于对照组,差异均有统计学意义(P﹤0.01).有淋巴结转移、间质浸润深度≥10 cm早期宫颈癌患者的RI、PI均低于无淋巴结转移、间质浸润深度﹤10 cm的患者(P﹤0.05);不同淋巴结转移情况、间质浸润深度、脉管受累情况、病灶直径、宫旁浸润情况、临床分期早期宫颈癌患者微血管内的血流情况比较,差异均有统计学意义(P﹤0.05).血流不丰富、不明显早期宫颈癌患者的RI、PI均高于血流丰富的患者,血流不明显早期宫颈癌患者的RI、PI均高于血流不丰富的患者,差异均有统计学意义(P﹤0.05).Logistic回归分析结果显示,有淋巴结转移、间质浸润深度≥10 cm、有脉管受累、病灶直径≥18 cm、有宫旁浸润、临床分期为Ⅱ期、RI≤0.82、PI≤1.62、血流丰富均是早期宫颈癌患者预后的独立危险因素(P﹤0.05).结论 早期宫颈癌病灶内微血管血流情况及血流动力学参数RI、PI均与患者的临床特征有关,且RI、PI越低,血流越丰富,患者预后不佳的风险越高.     

计算机图像分析技术结合超声造影在肾肿瘤术后随访中的应用

目的:探讨计算机图像分析技术结合超声造影检查在肾肿瘤术后随访中的应用价值,提高复发肾肿瘤的诊治水平.方法:对27例肾肿瘤患者术后进行定期超声造影随访,比较分析其病灶定量参数变化鉴别良恶.结果:3例肾肿瘤患者术后新发病灶定量参数最大峰值强度(IMAX)和曲线下面积(AUC)变化差异显著,术后病理证实为肿瘤复发.结论:超声造影结合计算机图像分析技术可以更早、更准地判断出肿瘤术后复发情况,是肾肿瘤术后随访的一种有效手段.     

卵巢良恶性肿瘤血流动力学肿瘤标记物及经阴道彩色多普勒超声鉴别诊断的效果分析

目的探讨卵巢良恶性肿瘤血流动力学、血清肿瘤标记物糖类抗原-125 (CA125)和人附睾蛋白4 (HE4)的差异,采用受试者工作特征曲线(ROC)分析经阴道彩色多普勒超声鉴别诊断卵巢良恶性肿瘤的价值。方法选取2016年1月至2018年1月间上海市闵行区梅陇社区卫生服务中心收治的140例单侧单发卵巢肿瘤患者,均接受手术治疗,术前均完善彩色多普勒超声检查及血液生化检查,将52例卵巢恶性肿瘤患者纳入观察组,88例良性肿瘤患者纳入对照组,比较两组患者肿瘤血流动力学、血清肿瘤标记物CA125以及HE4水平的差异。以手术病理为金标准,分析经阴道多普勒超声鉴别诊断卵巢良恶性肿瘤的灵敏度、特异度,并采用ROC曲线分析经阴道多普勒超声鉴别诊断卵巢良恶性肿瘤的临床价值。结果观察组患者内部回声实性率及病灶周围血管血流信号Ⅲ～Ⅳ级发生率均高于对照组患者,囊性、囊实性以及Ⅰ～Ⅱ级发生率均低于对照组患者,差异均有统计学意义(均P <0. 05)。观察组患者搏动指数(RI)和阻力指数(PI)均小于对照组患者,血流速度(PSV)和舒张末期流速(EDV)均高于对照组患者,且差异均有统计学意义(均P <0. 05)。观察组患者血清CA125和HE4水平均明显高于对照组患者,差异均有统计学意义(均P <0. 05)。经阴道彩色多普勒超声诊断的灵敏度为92. 3%,特异度为90. 9%,阳性预测率为85. 7%,阴性预测率为95. 2%,准确率为91. 4%。采用ROC曲线分析,经阴道彩色多普勒超声提示AUC=0. 916,95%CI为(0. 862,0. 971)。结论经阴道彩色多普勒超声在卵巢良恶性肿瘤患者的鉴别中应用价值较高,且卵巢良恶性肿瘤患者血清CA125和HE4水平存在显著差异,值得在临床诊治中关注。     

乳腺良恶性肿瘤微血管构筑的异质性及其血流动力学的功能变化

目的 探讨乳腺良恶性肿瘤及其不同灌注区域在血管构筑、血流动力学功能、超微结构及其微血管分布方面的差异性.方法 应用实时灰阶超声造影微血管成像(MVI)技术,检测30例乳腺恶性肿瘤(33个病灶)和30例乳腺纤维腺瘤(34个病灶)的微血管造影特征.应用时间-强度曲线(TIC)定量分析技术,检测瘤灶边缘及中心部区域灌注参数及平均灌注参数峰值强度(PI)、曲线下面积(AUC)、达峰时间(TTP)和廓清时间(WOT).应用透射电镜观察瘤内新生血管超微结构改变,应用免疫组化技术检测CD34的表达.结果 乳腺良恶性肿瘤造影后,病灶呈不均匀增强、充盈缺损、紊乱的血管网、血管扩张、血管迂曲征象的差异有统计学意义(P<0.05).恶性组病灶中,TIC多数(29/33,87.9%)呈速升缓降型;良性组病灶中,TIC多数(27/34,79.4%)呈缓升速降型.恶性组平均AUC和WOT大于良性组(P<0.05).两组平均PI和TTP比较,差异无统计学意义(P0.05).恶性组病灶边缘各灌注参数与中心区域相比,差异有统计学意义(P<0.05);良性组病灶边缘各灌注参数与中心区域相比,差异无统计学意义(P>0.05).恶性组新生血管内皮细胞超微结构不同于正常血管内皮细胞,具有分裂旺盛的瘤性特征,痛灶边缘以扩张、迂曲的大血管为多,癌灶中心常见狭窄、闭塞的幼稚新生血管及固缩、变形的内皮细胞和周细胞.恶性组的微血管密度(34.84±8.34)显著高于良性组(18.65±4.69,P<0.05),微血管丰富区位于痛巢边缘.结论 实时超声造影灌注模式、TIC形态、各平均灌注参数及区域灌注参数的差异,为乳腺良恶性肿瘤的鉴别诊断提供了重要依据.肿瘤间质中新生微血管密度、形态、分布、结构及功能的差异性,是影像学评价肿瘤血管生成的基础.     

经阴道彩色多普勒超声病灶内微血管情况与早期宫颈癌预后的相关性研究

目的 探讨经阴道彩色多普勒超声病灶内微血管情况与早期宫颈癌预后的相关性.方法 早期宫颈癌患者50例,经阴道彩色多普勒超声检查病灶内微血管情况,根据多因素Logistic回归分析,将单因素带入Cox回归方程计算影响病灶内血流情况的危险因素,探讨血流情况与早期宫颈癌预后的相关性.结果 超声探查,血流丰富者27例,少量血流者或缺乏血流者23例(46.0％).早期宫颈癌病灶血流丰富情况与宫旁浸润、病灶大小、累及脉管、间质浸润深度、淋巴结转移等因素密切相关(P＜0.05).病灶血流丰富者预后较佳7例(25.9％),病灶血流较少或缺乏血流者预后较佳20例(87.5％),差异有统计学意义(P＜0.05).结论 宫颈癌病灶内血流情况与是否出现宫旁浸润、病灶大小、是否累及脉管、间质浸润深度、淋巴结转移等因素密切相关,血流丰富的患者预后较差.     

超声联合CT在宫颈癌鉴别诊断中的价值

目的探讨超声联合CT在宫颈癌中的鉴别诊断价值。方法选取2017年1月至2019年6月间延安市中医医院收治的135例宫颈占位性病变患者,其中65例宫颈癌患者纳入宫颈癌组,70例宫颈良性病变患者纳入良性组。两组患者均采用超声联合CT诊断,记录影像学特征,判断鉴别诊断价值。结果宫颈癌组患者病灶微钙化、内部回声不均匀、侧方声影、回声衰减、边界不清晰和形态不规则等比例均高于良性组,差异均有统计学意义(均P <0. 05)。宫颈癌组患者开始灌注时间、开始灌注强度和峰值时间都少于良性组,峰值强度高于良性组,差异均有统计学意义(均P <0. 05)。宫颈癌组患者分叶征、锯齿征、毛刺征和空泡征等比例均高于良性组,差异均有统计学意义(均P <0. 05)。超声联合CT鉴别诊断宫颈癌64例,宫颈良性病变71例,超声联合CT在宫颈癌中鉴别诊断敏感性与特异性分别为98. 4%(63/64)和97. 2%(69/71)。结论超声联合CT在宫颈癌的应用中具有很高的敏感性与特异性,可促进早期宫颈癌变检出。     

组织四维动态增强磁共振成像灌注参数与肝癌微血管密度相关性研究

目的 探讨组织四维动态增强(tissue 4 dimensional-dynamic contrast enhanced,T4D-DCE)磁共振成像(MRI)灌注参数在评估原发性肝癌(primary liver cancer,PLC)微血管密度(microvessel density,MVD)中的价值.方法 51例PLC患者行T4D-DCE MRI成像,并用Tissue-4D软件分析病灶和正常肝组织的灌注参数:转运常数(Ktrans)、血管外细胞外间隙体积百分比(Ve)、速率常数(Kep),将病灶灌注参数和正常肝组织灌注参数的比值作为病灶相对灌注参数与病理结果进行对比.结果 各灌注参数与PLC病理等级均无相关性(P＞0.05).Ktrans病灶、Ktrans相对、Kep相对与MVD均存在正相关(r=0533、0.791、0.717,P＜0.001).结论 T4D-DCE能直观反映PLC的血流灌注信息,在诊断PLC及评估PLC微循环特征中具有重要参考价值.     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.