麦冬类中药组织切片计算机三维重建图鉴

利用计算机技术实现麦冬类中药组织连续切片三维重建与动态显示,为计算机辅助生药学鉴定和教学提供了新的三维图像技术和研究资料。     

Conservative management of early endometrial adenocarcinoma with repeat curettage and hormone therapy under assistance of hysteroscopy and laparoscopy

We report a rare case of early-stage endometrial adenocarcinoma in a 22 year old nullipara with polycystic ovaries undergoing conservative treatment. Pretreatment evaluation including tumour grade, depth of myometrial invasion, tumour size, hormone receptor status and flow cytometric analysis indicated a favourable prognosis. The patient underwent repeat endometrial curettage and a 6 month period of therapy with megestrol acetate and tamoxifen. A combination contraceptive pill was then prescribed to ensure withdrawal of the menstrual cycle thereafter. Now, 1 year after the last curettage, there is no evidence of disease. During the treatment period, hysteroscopy allowed for a more precise approach in panoramically examining the tumour nest in the endometrial cavity, and the subsequent endometrial response to hormone therapy. Laparoscopy using bulldog clamps applied to the isthmic portion of the Fallopian tubes prevented i.p. spread of endometrial tissue from retrograde regurgitation during hysteroscopy. Laparoscopic ovarian electrocautery resulted in the reduction of abnormal hypervascularization on the surface of polycystic ovaries postoperatively but caused a peri-ovarian adhesion complication. It is interesting that this case posed a unique opportunity to demonstrate the tumour regression under the assistance of laparoscopy and hysteroscopy.      

CDKN1A and CDKN1B polymorphisms and risk of advanced prostate carcinoma

A multigenic model of prostate cancer susceptibility has been proposed, in which common polymorphic variants of genes, such as the androgen and vitamin D receptor, contribute to tumorigenesis. The discovery of additional genetic factors that contribute to prostate cancer risk should provide opportunities for new approaches to the detection and treatment of this common malignancy. Herein, we examined single nucleotide polymorphic variants in the 3'-untranslated region of CDKN1A (p21(cip1)) and in codon 109 of CDKN1B (p27(kip1)) for association with advanced prostate cancer in a European-American population. Ninety-six cases and 106 controls were analyzed using PCR amplification and restriction digestion assays. CDKN1A genotype was scored as CC, CT, and TT on the basis of the digestion products. The CDKN1A genotypes CT and TT were associated with an increased risk of advanced prostate carcinoma compared with the CC genotype [odds ratio (OR), 2.24; 95% confidence interval (CI), 1.02-4.95]. The CDKN1B genotype was scored as VV, VG, or GG, again on the basis of the digestion products. The CDKN1B genotype VV was also associated with an increased risk of advanced prostate carcinoma (OR, 1.95; 95% CI, 1.09-3.47). These associations were particularly strong in those patients with androgen-independent disease [OR = 2.88 (95% CI, 1.19-6.97) and 2.11 (95% CI, 1.05-4.22) for high-risk genotypes of CDKN1A and CDKN1B, respectively]. In addition, the association of CDKN1B was particularly strong in the cohort of patients under the median age of diagnosis (OR, 2.23; 95% CI, 1.08-4.59). These results suggest that in a European-American population, CDKN1A and CDKN1B variants are associated with advanced prostate cancer. Analysis of CDKN1A and/or CDKN1B genotypes may prove useful in determining which patients are at risk for developing advanced prostate carcinoma and therefore would gain the most from aggressive screening, prophylaxis, and/or treatment.     

Antegrade approach to radical retropubic prostatectomy in patients with difficult apical dissection

Among 335 radical retropubic prostatectomies an antegrade dissection was used in 30 because of difficulty in developing the usual planes of dissection during apical dissection. The adequacy of tumor resection, preservation of sexual potency and urinary continence were compared in patients who underwent the antegrade dissection and those who underwent the standard retrograde nerve-sparing radical retropubic prostatectomy. Histopathological evaluation revealed no significant difference in the over-all completeness of tumor excision between the group having an antegrade dissection (16 of 30, 53% completely excised) and those having a retrograde dissection (177 of 305, 58% completely excised) (p = 0.62). Patients with clinically localized but pathological stage C disease undergoing an antegrade dissection and a nerve-sparing procedure had a significantly higher incidence of positive lateral margins (9 of 12, 75%) than the comparable group undergoing a retrograde dissection (40 of 99, 40%) (p = 0.02). The incidence of positive apical margins was similar in both groups, with 5 of 14 (36%) of the antegrade stage C cases (36%) having positive apical margins compared to 37 of 117 of the retrograde stage C cases (32%) (p = 0.65). Sexual potency was preserved in 5 of 6 patients (83%) treated with an antegrade dissection who had both neurovascular bundles preserved and were followed for at least 6 months, compared to 86 of 142 (61%) who underwent retrograde dissection (difference not significant, p = 0.26). Potency was preserved in 6 of 13 evaluable patients (46%) undergoing unilateral antegrade nerve-sparing procedure compared to 21 of 48 evaluable patients (44%) undergoing unilateral retrograde nerve-sparing procedure (p = 0.88). Of 22 patients followed for 1 year 21 (95%) have regained urinary continence. We conclude that the antegrade approach to radical retropubic prostatectomy provides results that are comparable to those achieved with the standard retrograde approach but that when an antegrade approach is chosen because of periprostatic fibrosis, bilateral preservation of the neurovascular bundles may result in a higher incidence of positive surgical margins.