甲状腺恶性肿瘤诊断和治疗的热点讨论

对近年有关甲状腺恶性肿瘤的实验室检查的诊断手段和包括手术、核素、放射、化学治疗及甲状腺激素抑制等治疗方法的资料作一介绍及评论。     

原发性胆囊恶性肿瘤的B超诊断及B超误诊病例分析

目的分析老年组胆囊恶性癌肿的声像图特点及B超误诊原因,探讨早期B超诊断。方法回顾性分析了经B超诊断,并经手术、病理证实37例老年胆囊恶性肿瘤病例。结果本组B超诊断符合率为75．7％(28/37),误诊率为24．3％。经B超检查发现而手术者,预后好。仅从声像图特征难以区别胆囊腺癌与非腺癌类肿瘤。结论病人早期就诊行B超检查可以改善预后。     

Tumor size is irrelevant in predicting malignant potential of carcinoid tumors of the rectum

The malignant potential and prognosis of rectal carcinoids are said to be related to tumor size. Our study assessed if size could predict the malignant potential and hence its management. All patients in the Department of Colorectal Surgery, Singapore General Hospital, who underwent surgery for rectal carcinoid tumors between February 1991 and September 2000 were analyzed. Twenty patients (11 men), median age 48 years (range, 33–77 years) were studied. Median follow-up was 40 months (range, 5–120 months). The median tumor diameter was 2.5 cm (range, 0.1–5.0 cm). Eleven patients underwent radical resection and 9 patients had local resection for a presumed benign tumor. Morbidity was 15% and postoperative death was 5%. Overall median survival was 24 months (range, 5–120 months). One patient had an anterior resection for rectal adenocarcinoma but had an incidental 0.1-cm carcinoid tumor near the resection margin which on histology was found to have carcinoid tumor metastasis to 2 out of 12 lymph nodes. In conclusion, tumor size cannot predict malignant potential as even small tumors (<1 cm) can be malignant. Accurate preoperative staging with radical surgery may be required. Received: 20 September 2000 / Accepted in revised form: 6 April 2001     

原发性胆囊恶性肿瘤的B超诊断及B超误诊病例分析

目的分析老年组胆囊恶性癌肿的声像图特点及Ｂ超误诊原因，探讨早期Ｂ超诊断。方法回顾性分析了经Ｂ超诊断，并经手术、病理证实３７例老年胆囊恶性肿瘤病例。结果本组Ｂ超诊断符合率为７５．７％（２８／３７），误诊率为２４．３％。经Ｂ超检查发现而手术者，预后好。仅从声像图特征难以区别胆囊腺癌与非腺癌类肿瘤。结论病人早期就诊行Ｂ超检查可以改善预后。     

Chemotherapy for malignant brain tumors of astrocytic and oligodendroglial lineage

To date, surgery and irradiation remain the standard therapies for anaplastic astrocytoma (AA, WHO grade III) and glioblastoma multiforme (GBM, WHO grade IV). Due to infiltrative tumor growth a complete surgical resection is never achieved and more than 90% of the tumors will recur within 2 cm of the primary tumor location. Postoperative radiotherapy prolongs survival but is not curative and prognosis remains poor with only a few patients being alive 2 years after diagnosis. Over the past decades multiple trials dealt with the question of whether chemotherapy (CT) may influence the outcome of malignant brain tumor patients. In general, the results have been disappointing with one exception: chemosensitivity and prolonged survival after CT have been demonstrated for tumors of oligodendrogial lineage. Drugs showing some activity in malignant brain tumors and therapeutic concepts will be discussed. Received: 2 May 2000 / Accepted: 28 May 2000     

mdig基因功能与恶性肿瘤

肿瘤是多基因病,对癌基因作用及调控机制的研究已成为热点。矿物粉尘诱导基因(mineral dust induced gene,mdig)是新发现的肿瘤相关基因,过表达于多种恶性肿瘤,可促进癌细胞增殖,参与癌细胞侵袭、转移。研究 mdig 将进一步揭示肿瘤发生、发展机制,协助临床诊断,提供肿瘤治疗新思路和方法,以期评估、改善肿瘤预后。现将 mdig 基因功能及在肿瘤中的研究进展作一综述,并对未来研究趋势予以展望。     

Serum sialic acid in malignant tumors,bacterial infections,and chronic liver diseases

Summary The total serum sialic acid concentration was determined in 2,264 persons with various malignant tumors, bacterial infections, rheumatic diseases, and chronic liver diseases, and in a control group. The thiobarbiturate method according to Warren was used [34].The upper limit (95% percentile) in the control group was 2.23 mol/ml. Higher values were found in the groups with neoplasms (mean: 3.04 mol/ml), inflammatory diseases (e.g., pneumonia: 3.02 mol/ml), and active rheumatoid arthritis (3.05 mol/ml). In the group with malignant diseases, the sialic acid concentration at the time of diagnosis was highest for bronchial carcinoma (3.29 mol/ml) and lowest for breast cancer (2.58 mol/ml). In chronic liver diseases the mean sialic acid level was lower than in a heterogeneous group of noninflammatory and nonneoplastic diseases.The estimation of the serum sialic acid concentration could be useful in the detection of tumor burden and metastases, and in the evaluation of the later course and prognosis of malignant neoplasms if bacterial/inflammatory and active rheumatoid processes can be excluded.     

FOXA在消化系统恶性肿瘤中的作用研究进展

FOXA又称叉头盒转录因子A,最初是从大鼠肝核细胞中发现并提取,分为FOXA1、FOXA2、FOXA3,在胚胎发育、代谢、分化、生长等多个方面发挥着重要作用.近年来研究表明,FOXA在肿瘤代谢、增殖、迁延和转移特别是在上皮间充质转化(EMT)进程中发挥着重要的调节作用.该文对FOXA在消化系统恶性肿瘤中的作用研究进展作...     

血管内皮生长因子和肿瘤特异性生长因子对恶性肿瘤的诊断价值

目的　探讨血管内皮生长因子 (VEGF)和肿瘤特异性生长因子 (TSGF)联合检测对恶性肿瘤诊断的价值。方法　采用酶联免疫吸附试验 (ELISA)和化学法分别检测了 10 4例恶性肿瘤 ,3 0例良性疾病患者和 3 0例正常血清中的VEGF和TSGF的含量。结果　恶性肿瘤患者血清中VEGF和TSGF的含量均明显高于正常对照组及良性疾病组 (P <0 0 1)。恶性肿瘤患者血清VEGF的阳性率为 84 6% ,TSGF的阳性率为 85 6% ,两者总阳性率为 94 2 %。结论　研究资料血清VEGF和TSGF含量异常有助于恶性肿瘤的诊断     

铜绿假单胞菌制剂在恶性肿瘤中的辅助治疗作用

当前,恶性肿瘤已越来越趋向于多方面的综合治疗.带有甘露糖敏感性血凝菌毛的铜绿假单胞菌(pseudomonas aeruginosa-mannosesensitive hemagglutinin,PA-MSHA)制剂是一类用于免疫治疗的生物制剂,正被应用于恶性肿瘤的治疗过程中.本文重点介绍PA-MSHA制剂对恶性肿瘤辅助治疗作用的研究进展.     

Immunohistochemical analysis of nm23 protein expression in malignant bone tumors

Expression levels of nm23 protein in 72 malignant bone tumors comprising 41 osteosarcomas, 22 chondrosarcomas, 6 Ewing's sarcomas, and 2 malignant fibrous histiocytomas were examined immunohistochemically, using anti-nm23 protein polyclonal antibody, and compared with 51 cases of benign bone tumors or tumor-like lesions. Malignant bone tumors showed significantly higher nm23 protein expression than benign bone tumors or tumor-like lesions (P<0.0001). In chondrosarcoma, nm23 expression increased in high-grade tumors (grade I versus grade II and III:P=0.0229). In the cases of osteosarcoma, however, grade IV osteosarcomas showed decreased expression of nm23 compared with grade III tumors (P=0.0122). There was no significant relationship between nm23 expression and histological type. nm23 expression had no correlation with metastatic potential in osteosarcoma, although the therapy was not uniform in our cases. Furthermore, in 6 cases of osteosarcoma and 1 case of Ewing's sarcoma, there was no clear tendency for a decrease of nm23 in the metastatic sites compared with primary sites, as reported in breast cancer. These results showed that, in contrast to reports on breast cancer and experimental models, nm23 protein expression in human bone tumors may be associated with malignant potentiality, except in cases of osteosarcoma.     

核医学显像与胰腺内分泌肿瘤的诊断和治疗

胰腺内分泌肿瘤(EPTs)是一组具有不同临床表现、生物学行为以及预后的肿瘤的总称;其显著特征为大部分肿瘤细胞存在神经胺摄取机制和(或)细胞表面表达特殊受体,这些都为核医学显像在诊疗EPTs方面提供了依据.随着核医学技术的发展,尤其是PET与CT实现了解剖与功能的完美结合,核医学显像在探查EPTs微小病灶、早期发现转移灶以及治疗方面具有独到的优势.     

Clinical management of malignant adrenal tumors

Malignant primary adrenal tumors are rare forms of cancer with an estimated incidence of two to ten new cases per one million inhabitants per year. The 5-year survival rate for adrenocortical carcinoma is approximately 35%, whereas the 10-year survival rate of malignant pheochromocytoma reaches 40%. Clinical studies support repeated surgery as the mainstay of treatment, either with curative or palliative intention. For adrenocortical carcinoma, adjunctive treatment with oral mitotane leads to well-documented improvement of survival. Rare malignant pheochromocytomas with distant metastases are preferably treated by ¹³¹I-MIBG. Chemotherapy is reserved for unresectable tumors without sufficient response to mitotane or ¹³¹I-MIBG, respectively. Cisplatin and etoposide as single therapy, or in combination with doxorubicine or etoposide, appear to be effective in adrenocortical carcinoma. Malignant pheochromocytoma may be treated with vincristine, dacarbazine, and cyclophosphamide. Treatment with octreotide is currently being evaluated. Radiotherapy is indicated if unresectable tumor masses cause local symptoms. If symptoms of endocrine activity are not sufficiently controlled by measures aiming at tumor mass reduction, specific inhibitors of hormone synthesis or action are available. Ketoconazole is widely used for adrenocortical carcinoma, and phenoxybenzamine and metyrosine are available for malignant pheochromocytoma. This review provides guidelines for rational disease management based on still scanty clinical evidence. Received: 5 May 2000 / Accepted: 28 May 2000     

气道恶性肿瘤患者光动力治疗24例临床分析

目的回顾性分析经电子支气管镜腔内激光光动力疗法(photodynamic therapy, PDT)治疗的气道恶性肿瘤患者临床资料,探讨PDT治疗的规律性。 方法选择2019年2月至2021年3月由我院呼吸与危重症医学科进行PDT治疗的气道恶性肿瘤患者24例,分别对一般临床资料、PDT治疗情况和治疗后随访,以及治疗后存活患者和死亡患者的特征进行分析。 结果截止2021年8月7日,PDT治疗后获益最大的患者随访时长达13.2个月,远远大于PDT治疗后获益较小患者的随访时长总生存期(overall survival, OS)4.7个月(P＝0.02)。前者以管腔壁型为主(80%),而后者以管腔内型为主(50%)(P＝0.034)。前者腔内病变短于后者(中位数分别是3 cm和5 cm,P＝0.03)。前者年轻、病程短、以腺样囊性癌为主,而后者年龄大、病程长、以鳞癌为主(P>0.05)。 结论管腔壁型、气道腔内病变短,以及年轻、病程短和肺腺样囊性癌的气道恶性肿瘤患者可能在PDT治疗中获益较多;相反,管腔内型、气道腔内病变长,以及年老、病程长和非肺腺样囊性癌的气道恶性肿瘤患者可能在PDT治疗中获益较少。     

Personalized treatment of malignant tumors during pregnancy

The combination of pregnancy and cancer is a challenge for the patient and a problematic clinical dilemma for the doctor. In this retrospective observational cohort study, we have tried to analyze our experience in the management of such patients.This review includes 41 patients with malignant neoplasms detected during pregnancy who received treatment at the Almazov National Medical Research Centre from 2015-2021.The majority of patients received treatment during pregnancy (n=26, 63.4%): chemotherapy – 19 (46.3%) (in 2 cases in combination with surgery), surgical treatment – 7 (17, 1%) patients. In most cases, delivery was at term (n=28, 68.3%). All children born at term were mature and had no growth restriction, regardless of whether the mothers received treatment during pregnancy or not.When detecting cancer during pregnancy, an immediate follow-up examination is required to assess the extent of the tumor and current fetal state. If pregnancy prolongation is requested, the treatment should not be postponed, except for systemic chemotherapy in the first trimester of pregnancy, pelvic radiation at any term.     

联合抗反转录病毒治疗对艾滋病合并恶性肿瘤的影响

目的:探讨联合抗反转录病毒治疗(combination antiretroviral therapy,cART)后艾滋病合并恶性肿瘤的流行趋势及发生风险的变化。方法:在国家艾滋病综合防治信息系统中筛选出2004年1月1日至2018年12月31日的湖北籍人类免疫缺陷病毒(human immunodeficiency virus,HIV)抗体阳性患者,分析其在不同cART阶段的艾滋病合并恶性肿瘤的肿瘤类型。以2013年湖北省或全国普通人群恶性肿瘤的发病率为对照,分析艾滋病人群中的恶性肿瘤标准化发病率(standardized incidence ratios,SIR),并比较2004年至2013年与2014年至2018年不同cART阶段艾滋病合并恶性肿瘤的发生风险变化。统计学方法采用χ²检验。结果:共纳入22994例艾滋病患者,其中艾滋病合并恶性肿瘤323例。艾滋病相关恶性肿瘤(acquired immunodeficiency syndrome-defining cancers,ADC)以非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL)和宫颈癌常见,非艾滋病相关恶性肿瘤(non-acquired immunodeficiency syndrome-defining cancers,NADC)以肝癌、肺癌常见。与普通人群比较,艾滋病人群的总体恶性肿瘤发生风险并未增加(SIR=1.06,χ²=0.62,P=0.426),但卡波西肉瘤、NHL、霍奇金淋巴瘤、宫颈癌和除鼻咽癌外的头面部癌的发生风险显著升高(SIR=834.09、9.65、13.33、5.22、2.94,χ²=11747.27、625.54、56.65、184.21、13.66,均P<0.01),肺癌、结直肠肛门癌、胃癌和乳腺癌的发生风险显著降低(SIR=0.33、0.36、0.43、0.45,χ²=33.43、12.84、9.01、7.21,均P<0.05)。2014年至2018年宫颈癌、肝癌和结直肠肛门癌的SIR分别为4.06、0.43和0.10,分别低于2004年至2013年的7.42、1.96和0.84,差异均有统计学意义(χ²=5.39、19.52、10.86,均P<0.05)。结论:目前艾滋病合并恶性肿瘤的发病率与普通人群无明显差异,但肿瘤类型存在差异。本地区最常见的恶性肿瘤是NHL和宫颈癌,应注意在该类肿瘤患者中筛查HIV,有助于开展综合治疗以提高疗效。     

Cytofluorimetric measurements on the DNA contents of tumors cells in human thyroid gland

Summary The relative DNA contents of thyroid cell nuclei were measured in surgically removed thyroid tissue of 50 patients by means of cytofluorimetry. Smears were prepared immediately after removal of the thyroid nodules according to the classical Feulgen technique. The fluorescence intensities were always compared with those of healthy thyroid tissue prepared in the same way. In each case samples were investigated by the usual histology. The observations indicate that differentiated carcinomas of thyroid gland, have an increased DNA content of nuclei, at about the tetraploid level. Among them the follicular carcinomas (11 cases) showed an even higher DNA content of about 250% of the diploid level. Frequency distribution of the cell pools studied revealed a widely scattered aneuploidization of the malignant tumor cells. The benign adenomas displayed only a moderate increase of nuclear DNA content reaching only about 130% of the diploid value. Among the 22 adenomas classified histologically as of benign character, two cases showed very highly increased and widely scattered DNA contents. These latter two cases might be in process of malignant transformation. DNA cytofluorimetry may contribute to a more safe differential diagnosis of the follicular neoplasia of the thyroid gland.     

Contributions of general internal medicine teaching units

OBJECTIVE: To identify and describe general internal medicine teaching units and their educational activities. DESIGN: A cross-sectional mailed survey of heads of general internal medicine teaching units affiliated with U.S. internal medicine training programs who responded between December 1996 and December 1997. MEASUREMENTS AND MAIN RESULTS: Responses were received from 249 (61%) of 409 eligible programs. Responding and nonresponding programs were similar in terms of university affiliation, geographic region, and size of residency program. Fifty percent of faculty received no funding from teaching units, 37% received full-time (50% or more time), and 13% received part-time (under 50% time) funding from units. Only 23% of faculty were primarily located at universities or medical schools. The majority of faculty were classified as clinicians (15% or less time spent in teaching) or clinician-educators (more than 15% time spent in teaching), and few were clinician-researchers (30% or more time spent in research). Thirty-six percent of faculty were internal medicine subspecialists. All units were involved in training internal medicine residents and medical students, and 21% trained fellows of various types. Half of the units had teaching clinics located in underserved areas, and one fourth had teaching clinics serving more than 50% managed care patients. Heads of teaching units reported that 54% of recent graduating residents chose careers in general internal medicine. CONCLUSIONS: General internal medicine teaching units surveyed contributed substantial faculty effort, much of it unfunded and located off-campus, to training medical students, residents, and fellows. A majority of their graduating residents chose generalist careers. Presented at the national meeting of the Society of General Internal Medicine, April 1998, and the Bureau of Health Professions, June 1998. This work was supported by the Division of Medicine, Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Md, grant 103HR960470P000-000; and the Society of General Internal Medicine.