DIAGNOSIS AND TREATMENT OF THE MALIGNANT GESTATIONAL TROPHOBLASTIC TUMOR WITH PULMONARY METASTASIS COMPLICATED WITH PULMONARY TUBERCULOSIS

Objective. To evaluate the diagnosis and treatment for malignant gestational trophoblastie tumor (MGTT) with pulmonary metastasis complicated with pulmonary tuberculosis. Methods. To analyze ten cases of MGTT with pulmonary metastasis complicated with pulmonary tu-berculosis in oar hospital from 1980 to 1997 retrospectively, Results. From the x-ray film, there are great resemblances between MGTT with pulmonary metastasis and pulmonary tuberculosis. Of 10 patients, 7 of them were examined out pulmonary tuberculosis during the ehamotherapy of MGTT. Pulmonary tuberculosis appeared six months before chemotherapy in three eases, All of the patients were treated with multiagent chemotherapy. Seven patients achieved a complete remission, 2 patients developed drug resistance and died of cerebral haemorrhage and cerebral herniation, 1woman who had achieved a complete remission from MGTT for 14 months died of miliary tubereulosis. Condu.non. It is very important to make differential diagnosis oi the MGTT with pulraonary metasta-sis complicated with pulmonary tuberculosis, Trying to avoid excessive anti tumor treatment owing to mis-take pulmonary tuberculosis for pulmonary metastasis, and avoiding missing an opportunity of anti-tuber-culosis treatment because of missed diagnosis should be emvhasized.     

细胞外基质的表达与滋养细胞肿瘤的侵袭转移

目的 探讨层粘连蛋白和纤维粘连蛋白在滋养细胞肿瘤的发生及侵袭转移过程中的作用。方法 采用免疫组织化学方法检测１５例葡萄胎、６例侵蚀性葡萄胎和６例绒毛膜癌组织中层粘连蛋白和纤维粘连蛋白的表达状况。结果 葡萄胎、层粘连蛋白在绒毛上皮基膜呈强阳性表达,在间质呈阳性,纤维粘连蛋白在线间质内呈阳性表达。侵蚀性葡萄胎和绒毛膜癌,层粘连蛋白和纤维粘连蛋白在细胞浆中呈强阳性表达,在细胞间质内呈弱阳性或阴性表达。结     

THE ROLE OF HYSTERECTOMY IN THE THERAPY OF GESTATIONAL TROPHOBLASTIC TUMOR

Objective. To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor. Methods. We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hys-terectomy from 1985～1997 at PUMC hospital. Thirty-eight cases were diagnosed of choriocarcinoma and 30 were invasive mole. Results. Twenty-three elder patients who didn‘t desire to preserve fertility were selected for hysterec-tomy after shorter courses of chemotherapy, 22 of them had a complete remission (95.6 % ), the total aver-age courses of chemotherapy was 4.2. Of twenty-seven chemorefractory cases who were suspected of a re-fractory isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed, 20 of them got a complete remission (74.1% ), the total average courses of chemotherapy were 9. 4. Emer-gency hysterectomy is indicated in 18 patients with uterine perforation or life-threatening hemorrhage, 17 cases had a complete remission (94.4 % ), the total average courses of chemotherapy were 7.6. Conclusion. Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjuncts in the treatment of a selected subset of patients; in order to operate more completely and prevent recurrence, it‘s better to perform extended hysterectomy for the indicated patients.     

恶性滋养细胞肿瘤的脊髓转移(附2例报告)

本文报告恶性滋养细胞肿瘤脊髓转移2例,占同期该病住院患者的1％。经治疗,恶性葡萄胎脊髓转移者1例完全恢复健康,另1例绒毛膜癌脊髓转移者效果不佳。本文就恶性滋养细胞肿瘤的脊髓转移机制及诊断、治疗中的问题作了讨论。     

妊娠滋养细胞肿瘤中PCNA表达的研究

目的：研究妊娠滋养细胞肿瘤(GTT)中PCNA的表达意义。方法：采用免疫组化S—P法检测了10例正常早期绒毛(NP)、10例完全性葡萄胎(CM)、20例侵袭性葡萄胎(IM)、19例绒癌(CCA)中PC—NA的表达。结果：PCNA在NP、CM、IM和CCA中表达率分别为10．40％、20．76％、53．60％、51．95％，各组间差异有统计学意义。结论：恶性GTT、中细胞增殖活性增高，PCNA的检测有助于良恶性GTT的鉴别。     

免疫抑制患者并发肺结核的诊断探讨

２４例并发于免疫抑制患者的肺结核，其７５．０％早期症状轻微或隐匿，平均确诊时间长达２６．１ｄ，６２．５％病例被误诊。Ｘ线表现与一般肺结核有明显不同：血播型多见，占５８．３％，病灶多呈小结节状的软性阴影，缺乏典型粟粒状改变；浸润型肺结核以均匀一致絮状或片状阴影多见，缺乏“多形性”特点：肺门和（或）纵隔淋巴结肿大和胸腔积液并发率较高、均为２５．０％。纤维支气管镜（纤支镜）采样总诊断率为７０．８％。病死率为２５．０％。     

肺结核合并糖尿病的护理

目的提高对肺结核合并糖尿病患者护理重要性的认识。方法将在本院接受治疗的肺结核合并糖尿病患者68例的护理进行分析。结果通过有效的治疗护理措施,肺结核合并糖尿病患者的预后良好。结论行之有效的护理措施,科学的服药方法、合理的饮食方法、适当的体育锻炼及持续的血糖监测,均使血糖控制在正常范围或略高于正常值,能明显减少肺结核合并糖尿病的不良预后。     

B 型超声对滋养层细胞肿瘤诊断的评价

报告我院B 型超声诊断,经病理证实的滋养叶细胞肿瘤58例。诊断准确率良性滋养叶细胞肿瘤为96%,恶性滋养叶细胞肿瘤为77%。通过观察子宫大小、外形、宫腔内容、肌层、浆膜层的内部回声以及子宫周围组织的变化,总结出良、恶性滋养叶细胞肿瘤的声象图诊断要点:良性滋养叶病变主要是胎盘绒毛回声变化,不侵犯肌层,不转移。恶性滋养叶病变不但有上述改变,而且侵犯肌层和血管并向远处转移。同时亦讨论了滋养叶病变的病理特征。     

妊娠性滋养细胞疾病发病因素的分析

省级三家医院1987年住院确诊滋养性细胞疾病患者:良性葡萄胎30例,恶葡30例,绒癌20例,进行患者的病因和流行病学调查,对照组选自同期住院的正常产妇。病例组与对照组按1∶2配对.结果:单因素 Logisitic 回归模型分析方法,选出22个有相对意义的因子。多因素分析:年龄、孕早期使用激素史、丈夫初婚年龄、初潮年龄、怀孕次数、停房事天数等,有显著意义(P均<0.05或<0.01).     

肾上腺髓质素对肺结核与肺炎鉴别诊断的价值

目的 探讨肾上腺髓质素（AM）对肺结核与肺炎鉴别诊断的价值,为临床早期鉴别肺结核与肺炎提供新的可靠的理论依据。方法 用放射免疫方法分别检测肺结核与肺炎病人及正常对照组血浆中AM的含量,用方差分析进行统计学处理。结果 肺结核与肺炎病人血浆AM含量高于正常对照组（F=30．66,q=11．01、4．44,P〈0．05）;肺结核病人血浆AM含量明显高于肺炎病人（q=6．57,P〈0．05）。结论 AM可作为早期鉴别诊断肺结核与肺炎的实验室指标。     

多普勒超声对妊娠滋养层细胞病诊断及治疗的应用和发展

本文论述多普勒超声对妊娠滋养层细胞病的诊断及有关学者的研究成果,包括妊娠滋养层细胞病彩色多普勒超声图像特点及血流特征、彩色多普勒及脉冲多普勒对滋养层细胞肿瘤化疗及预后监测的价值和优越性及能量多普勒血流显像发展等.     

表皮生长因子受体表达与预测葡萄胎恶变相关性研究

目的研究表皮生长因子受体（epidermal growth factor receptor,EGFR）在妊娠滋养细胞疾病中的表达,探讨EGFR对预测葡萄胎恶变的价值。方法采用免疫组化方法,检测石蜡包埋的105例妊娠滋养细胞肿瘤组织和20例正常早孕绒毛组织EGFR蛋白表达水平。结果在合体滋养层,妊娠滋养细胞肿瘤组织和正常早孕绒毛组织均强表达EGFR蛋白;在细胞滋养层,正常早孕绒毛、非恶变组葡萄胎的EGFR蛋白表达高于恶变组葡萄胎、侵蚀性葡萄胎和绒癌的表达（P〈0.05,P〈0.05,P〈0.05）;而恶变组的EGFR蛋白表达强于侵蚀性葡萄胎和绒癌的表达（P〈0.05,P〈0.05）;EGFR蛋白表达在侵蚀性葡萄胎和绒癌之间差异无显著性（P〉0.05）。结论EGFR表达降低在妊娠滋养细胞疾病发生发展过程中起重要作用,并有可能成为预测葡萄胎恶变的一项新的指标。     

儿童原发性腹膜后恶性肿瘤的诊断与治疗

分析原发性腹膜后恶性肿瘤１２例。８３％以腹块和腹痛为主要症状，体征中腹块占９１．５％，以恶性淋巴瘤居首位占６１％。全组完全切除率为５８％，行脏器联合切除占２５％。完全切除加放疗、化疗３年存活率为２８．５％，部分切除及活检未给其它治疗者５例预后差，均１年内死亡，差别显著。     

室间隔缺损及动脉导管未闭并重度肺动脉高压的诊断及治疗

报告25例室间隔缺损并发肺动脉高压及17例动脉导管未闭并肺动脉高压的临床特点,主要是杂音变轻、变短,P_2亢强,心电图、X线摄像均显示双室大。前者有10例手术,9例治愈;后者全部病例都作了手术,16例治愈。作者认为,室间隔缺损、动脉导管未闭并发肺动脉高压者只要仍有左向右分流,仍可作手术治疗。     

DIAGNOSIS AND TREATMENT OF PULMONARY HAMARTOMA

From 1970 to 1997, 67 patients with pulmonary hemartocna were operated on in our hospital. There were 38 men and 29 women with a M/F ratio of 1.3 : 1. The mean age seas 47 years (range 21 to 82 years). The peak incidence was 40 to 60 years. 39% patients had pulmonary symptomst;hemoptysis,cough, phlegm and chest pain. All were solitary. 68. 7% tumors were located in right lung and 64.2% in upper or middle lobe. 80. 6% hemartomas were less than 3 cm in transverse diameter. On chest films, the opacity was homogeneous in 79.1% cases, heterogeneous in 20. 9% and calcifications in 9.0%. The vast majority of shadows were heterogeneous on CT films. Operation is the best treamumt for hamartomas.Postoperative mortality was 1.5% There was none recurrences and canceration during the follow-up (mean 14 years).     

DISCRIMINATION OF BENIGN AND MALIGNANT TROPHOBLASTIC NEOPLASMS WITH COMPUTER IMAGE ANALYSIS SYSTEM

采用计算机图像分析系统，对３０例良恶性滋养层肿瘤进行了定量检测。通过对１５种参数的定量测定，发现细胞核的面积、周长、形状因子等９种参数可用于良恶性滋养层肿瘤的识别，尤其是葡萄胎和侵袭性葡萄胎的分辨率可达１００％。本研究为通过刮宫样品鉴别侵袭性葡萄胎及葡萄胎提出了一种新的技术手段。     

肺结核病人耐药性分析与评价

①目的　探讨住院肺结核病人耐药现状 ,评价和指导临床用药。②方法　采用绝对浓度法对 2 76例痰结核菌涂片阳性病人进行 10种常用抗结核药物的耐药性检测。③结果　 2 76例病人总耐药率为 62 .3 1% ,初治组和复治组耐药率分别为 5 5 .2 2 %和 81.3 3 % ,两组比较差异有显著性 ( χ2 =15 .86,P <0 .0 0 1)。 2 76例病人多药耐药率为 19.92 % ,初治组和复治组耐 2种或以上药物的耐药率比较差异有显著性 ( χ2 =7.12～ 3 1.3 9,P <0 .0 1、0 .0 0 1)。 10种药物中 ,初治组异烟肼耐药率最高 ,为 14.93 % ;复治组盐酸乙胺丁醇耐药率最高 ,为 2 6.67%。两组同性别间耐药率比较差异有显著性 ( χ2 =14.70 ,P <0 .0 0 1;χ2 =7.0 1,P <0 .0 1)。④结论　肺结核病人初始耐药率和获得性耐药率及多药耐药率仍处于较高水平 ,必须进一步加强对结核病的监控     

恶性肿瘤颈部转移的热,放疗与单纯放疗效果对比

将６０例恶性肿瘤颈部转移患者随机分为热、放疗组（微波加温合并￣６０Ｃｏ放疗）和单纯放疗组，每组３０例。热、放疗组￣６０Ｃｏ照射剂量为Ｄ＿Ｔ６０～６５Ｇｙ，局部加温（肿瘤表面温度达４２～４３℃）每周２次，每次４０ｍｉｎ。单纯放疗组外照射总剂量Ｄ＿Ｔ５５～７５Ｇｙ，每周５次，每次２～２．５Ｇｙ，近期疗效显示，热、放疗组肿瘤全消率大于７０％，单纯性放疗组为３３．３％，二组差异显著（Ｐ＜０．０１）     

肺肿瘤，肺心病患者红细胞免疫功能的观察

本文用红细胞酵母菌花环率方法对３６例肺肿瘤、５５例肺心病患者红细胞免疫功能和９４例正常健康人红细胞免疫功能进行检测，结果表明：肺肿瘤、肺心病急性加重期患者红细胞免疫功能明显低于健康人，肺心病缓解期患者红细胞免疫功能有所恢复，肺心病合并多系统脏器功能衰竭患者红细胞免疫功能进一步降低。