Alternate methods for laparoscopic management of adnexal masses greater than 10 cm in diameter.

PURPOSE: We describe alternate laparoscopic methods for inspection and removal of large adnexal masses, and report our experience with 18 cases in which these methods were used. PATIENTS AND METHODS: Between April 1994 and January 2000, the first author performed operative laparoscopy on 18 patients, each of whom had at least one adnexal mass with maximum diameter greater than 10 cm. Mean patient age was 32 years (range 11 to 82). Seventeen of the 18 patients were premenopausal. All procedures were performed at one of two community hospitals in Seattle or at Yuan's General Hospital in Taiwan. Preoperative screening included pelvic exam, tumor markers, and ultrasound. RESULTS: One 82-year-old patient underwent planned laparoscopic bilateral oopherectomy. In the other 17 cases the operative goal was cystectomy or unilateral oopherectomy with conservation of reproductive function. Cystectomy was successfully performed in five of these cases (29.4%). The remaining 12 patients underwent either unilateral oopherectomy (10 cases, 58.8%), or unilateral salpingo oopherectomy (2 cases, 8.8%) due to the extent of their mass. Sixteen of the 18 cases in this series were successfully managed by a single laparoscopic surgery, one case required a second-look laparoscopy, and in one case a malignancy was found by histological analysis of permanent section, which required a second laparoscopy for staging and debulking. CONCLUSIONS: Large adnexal masses can be successfully managed with minimal hospital stay using laparoscopic techniques, when care is taken to avoid rupture and spillage of cyst contents, and thorough inspection of the mass and abdominal cavity is made possible. The probability of finding an unexpected malignancy is low. In those cases where a malignancy is found, appropriate cytoreductive staging surgery can be performed immediately.     

肾嫌色细胞癌的诊治（附4例报告）

目的 提高肾嫌色细胞癌的诊治水平。方法 回顾性分析4例肾嫌色细胞癌患者的临床资料。男3例，女1例，年龄34—76岁，平均52岁。结果 3例患者行肾癌根治术，1例行肾部分切除术。术后病理诊断为肾嫌色细胞癌，病理分期：pT1aNxMo 1例，pT1bNoMo3例。病理分级：G1 3例，G2 1例。免疫组织化学染色：CK8（低分子量细胞角蛋白）阳性，Vimentin（波型蛋白）阴性，Hale胶体铁阳性。随访4个月至8年，平均4年。4例患者均健在，无肿瘤复发或转移。结论 肾嫌色细胞癌是一种低度恶性的肾细胞癌，影像学检查对其诊断有重要帮助，确诊有赖于组织病理学检查，手术治疗后预后较好。     

The impact of prior radical prostatectomy in men with metastatic castration recurrent prostate cancer: a pooled analysis of 9 Cancer and Leukemia Group B Trials

PURPOSE: A prior report suggested that radical prostatectomy may confer a survival advantage to patients with metastatic castration recurrent prostate cancer. Therefore, a pooled analysis of 9 trials performed by Cancer and Leukemia Group B was done to determine if men with metastatic castration recurrent prostate cancer who underwent prior prostatectomy had improved clinical outcomes, such as overall, prostate specific, progression-free and PSA progression-free survival, than men who did not undergo prior prostatectomy. MATERIALS AND METHODS: Data from 9 multi-institutional trials performed by Cancer and Leukemia Group B were combined. Eligible patients had progressive prostate cancer during androgen deprivation therapy, Eastern Cooperative Oncology Group performance status 0-2, and adequate hematological, renal and hepatic functions. The proportional hazards model was used to assess the prognostic importance of radical prostatectomy for predicting clinical outcomes. RESULTS: Of 1,238 men 310 (25%) underwent prostatectomy. Median survival was 14.7 (95% CI 12.9-16.7) and 14.5 months (95% CI 13.5-15.7) in men who did and did not undergo prostatectomy, respectively. The HR for death was 1.03 (95% CI 0.90-1.19, p = 0.65) in men with vs without prostatectomy. CONCLUSIONS: Prior prostatectomy in men with metastatic castration recurrent prostate cancer who were subsequently enrolled on clinical trials for cancer treatment had similar survival compared to men who did not undergo prior prostatectomy. These data do not support another report suggesting that prior prostatectomy confers a subsequent survival advantage in men with castration recurrent prostate cancer.     

Kidneys From Standard-Criteria Donors With Different Severities of Terminal Acute Kidney Injury

ObjectivesHigh terminal serum creatinine level in a deceased donor has been reported as the second most frequent cause of refusal for kidney transplantation. A growing body of evidence has shown a comparable outcome of kidney transplantation from deceased donors with acute kidney injury (AKI). However, the influence of the severity of AKI on graft outcomes remains to be elucidated.MethodsIn this retrospective cohort study, 84 consecutive kidney transplants from 57 standard-criteria donors were classified into 4 groups by RIFLE (Risk, Injury, Failure, Loss of function, and End-stage renal disease) classification according to donor AKI severity before kidney procurement. The donor and recipient characteristics and graft outcomes were compared.ResultsOf 84 kidney transplants, 56, 11, 10, and 7 recipients were in the Non-AKI, Risk, Injury, and Failure groups. The mean terminal creatinine was 1.1, 1.6, 2.3, and 4.4 mg/dL in these 4 groups. However, the graft outcomes, including primary nonfunction rate, delayed graft function rate, acute rejection rate, renal function, graft survival and overall survival over the first 5 years had no statistical difference. A trend toward increasing delayed graft function rate as the severity of AKI increased was observed (Non-AKI, Risk, Injury, and Failure: 26.8%, 36.4%, 60.0%, and 57.1%, P = .099).ConclusionsOur study demonstrates that AKI before procurement does not cause adverse long-term graft outcomes. Standard-criteria donors with AKI are suitable for kidney transplantation, even with a high severity of AKI.     

基于临床随机对照试验的胰十二指肠切除术后消化道重建方式的系统评价

目的：系统评价胰十二指肠切除术（PD术）后不同的消化道吻合方式及相关辅助方法。方法检索万方数据库和PubMed、The Cochrane Library、Web of Science以及EMBASE等数据库中,关于PD手术后消化道吻合方式的临床随机对照试验（RCT）,采用Jadad量表对纳入文献进行质量分析,提取围手术期情况：包括手术时间、术中出血量、术后发生胰漏、胆漏、出血、胃排空延迟、死亡率、再次手术以及伤口愈合不良等并发症指标,采用RevMan 5．2软件进行Meta分析。结果17篇RCT研究共计2504例病例纳入分析,Meta分析结果显示,胰胃吻合组术后胰漏和胆漏的发生率明显低于胰肠吻合组（OR＝0．60,95％ CI：0．44～0．82,P＝0．00; OR＝0．33,95％ CI：0．13～0．82, P＝0．02）。胰肠吻合组中,胰管-黏膜吻合术与传统端端吻合术后总体并发症发生率以及术后胰漏、再次手术和围手术期死亡的发生率差异均无统计学意义（P＞0．05）。外支架管引流组的术后总体并发症发生率及胰漏、尤其是Ⅱ～Ⅲ级胰漏的发生率和住院时间均明显低于无支架管引流组（均P＜0．05）。结论 PD术后消化道重建方式,推荐采用胰胃吻合,辅以外支架管引流。     

香萱解郁方对血清剥夺诱导HT22细胞损伤模型的神经保护作用

探讨香萱解郁方含药血清对血清剥夺致小鼠海马神经元HT22细胞损伤模型的影响。方法 采用血清剥夺培养HT22细胞建立神经损伤体外模型,实验分为对照组、模型组和中药组［中药组A（含药血清15%浓度）、中药组B（含药血清20%浓度）］,各组血清剥夺12 h后,通过CCK8法检测各组细胞活力,确定15%浓度含药血清干预后细胞的存活率最高,设定为后续实验中药组的药物浓度。免疫荧光染色法检测神经元特异性微管蛋白（β-Tubulin Ⅲ）在各组中的表达,蛋白质免疫印迹法及qPCR法检测脑源性神经营养因子（BDNF）蛋白及其mRNA在各组中的表达。结果 在加药后培养12 h,中药组的细胞活力明显高于对照组与模型组（P＜0.001）。培养24 h,模型组细胞活力较对照组明显下降（P＜0.001）,中药组较模型组明显提高（P＜0.001）。培养36 h,模型组细胞活力较对照组显著下降（P＜0.001）,中药组较模型组明显提高（P＜0.001）。模型组BDNF蛋白含量及 BDNF mRNA表达量较对照组显著降低（P＜0.05,P＜0.001）,模型组少数神经元长出突起;中药组BDNF蛋白含量及BDNF mRNA表达量较模型组显著增加（P＜0.05）,中药组HT22细胞轴突突起长度和分支增加,β-Tubulin Ⅲ阳性表达明显增多。结论 香萱解郁方含药血清对血清剥夺诱导小鼠海马神经元HT22细胞损伤具有神经保护作用,可能与促进BDNF蛋白表达有关     

原发性肝癌组织生长激素受体的表达

为探讨重组人生长激素 (rhGH)在肝癌患者中的适用问题 ,采用放射配体法对 32例原发性肝癌 (HCC)组织进行了生长激素受体 (GHR)的检测。结果在 2 8例HCC组织检测到GHR ,GHR受体结合容量 (RT)为 (18 430 0± 4 16 33)fmol/mg蛋白 ,平衡解离常数 (Kd)为 (0 6 432± 0 196 1)nmol/L ,与正常肝组织相比 ,其RT降低 (P <0 0 5 ) ,Kd无显著性改变 (P >0 0 5 ) ;HCC组织GHR的结合容量与肿瘤大小呈负相关 ,而与肿瘤分化程度、患者是否合并肝硬化无明显相关 ;有 4例肝癌组织未检测到GHR存在。研究提示 :大多数原发性肝癌组织仍表达低水平GHR ,在其功能未明的情况下 ,rhGH在肝癌患者中的使用应慎重。     

MK-801对反复性脑缺血大脑皮层组织病理和超微结构的影响

目的：研究MK－801对反复性脑缺血大脑皮层组织病理和超微结构的影响。方法：应用光镜和电镜对比观察大鼠反复性与单次性脑缺血大脑皮层神经元的病理损害及应用MK－801治疗后的影响。结果：反复缺血组皮层损害明显重于单次缺血组：MK－801能显著改善反复脑缺血皮层神经元缺血性损伤和超微结构损害。结论：兴奋毒机制可能在反复缺血性服损伤中起着重要作用。     

95例乳腺癌保乳治疗近期观察

目的探讨乳腺癌保乳治疗的方法与疗效。方法95例Ⅰ-Ⅱ期原发性乳腺癌,施行局部扩大切除并腋窝淋巴结清扫,手术后患侧乳房接受放射治疗。结果手术后6个月随访,患者本人对保留乳房的满意率100％,十分满意者为92％。经随访2～51个月,平均随访17个月,仅1例同侧乳腺局部复发,2年局部复发率1．4％。无远处转移和死亡病例。结论Ⅰ-Ⅱ期乳腺癌实施保乳治疗,近期疗效满意,远期效果有待长期随访观察。     

锌酞菁脂质体光动力作用引起小鼠肿瘤的细胞程序性死亡

电镜观察了锌酞菁脂质体光动力作用引起小鼠ＭＳ－２纤维肉瘤的形态学变化。发现其作用很强，并对肿瘤细胞有明显的直接影响。肿瘤细胞的结构表现出明显的程序性细胞死亡（ａｐｏｐｔｏｓｉｓ，ｐｒｏｇｒａｍｍｅｄｃｅｌｄｅａｔｈ）的特点：胞核染色质凝聚边集、核固缩、核破裂、染色质凝块流失、胞质内吞噬现象、胞膜表面肿胀粗钝的胞突形成、细胞碎裂等。加深了对锌酞菁脂质体光敏作用机理的认识，但其详细的发生机制和调节途径有待阐明。