Detection of colorectal carcinoma on double contrast barium enema when double reporting is routinely performed: an audit of current practice

PURPOSE: To determine the sensitivity of double contrast barium enema (DCBE) in the detection of colorectal carcinoma (CRC) when double reporting is routinely performed. METHOD AND MATERIALS: Over a 1-year period all patients with a diagnosis of CRC within a large teaching hospital were identified. Using computer records, any patient with CRC who had had a DCBE within 5 years of diagnosis was identified. During this time period all DCBE were double reported by the radiographer or radiology trainee who performed the enema and by a consultant radiologist specializing in gastrointestinal radiology. RESULTS: Over the 1-year period 169 patients were identified with a diagnosis of CRC. Seventy patients had had a DCBE within the preceding 5 years. Sixty-four patients had had CRC diagnosed on the DCBE. One patient had a sessile polyp diagnosed, which was removed at colonoscopy and found to be an invasive adenocarcinoma. In five cases (7%) the CRC was not diagnosed on DCBE. In three cases the lesions could be seen retrospectively, in one case the lesion could not be seen and in one case the examination had been incomplete. CONCLUSION: In our series the miss-rate for CRC was 7%. Previous studies have shown miss-rates of 15-24%. These studies have not routinely employed double reporting. Our results suggest that double reporting of DCBE significantly reduces the miss-rate and that this reduction is due to fewer perceptive errors.     

The Role of Sonography in Patients with Breast Cancer Presenting as an Axillary Mass

Objective

To compare sonography and mammography in terms of their diagnostic value in breast cancer cases which initially presented as an axillary mass without a palpable mass or other clinical symptoms.

Materials and Methods

Seven patients with enlarged axillary lymph nodes who first presented with no evidence of palpable breast lesions and who underwent both mammography and sonography were enrolled in this study. In six of the seven, the presence of metastatic adenocarcinoma was confirmed preoperatively by axillary needle aspiration biopsy; in four, subsequent sonographically-guided breast core biopsy performed after careful examination of the primary site indicated that primary breast cancer was present. In each case, the radiologic findings were evaluated by both breast sonography and mammography.

Results

Breast lesions were detected mammographically in four of seven cases (57%); in three of the four, the lesion presented as a mass, and in one as microcalcification. In three of these four detected cases, fatty or scattered fibroglandular breast parenchyma was present; in one, the parenchyma was dense. In the three cases in which lesions were not detected, mammography revealed the presence of heterogeneously dense parenchyma. Breast sonography showed that lesions were present in six of seven cases (86%); in the remaining patient, malignant microcalcification was detected at mammography. Final pathologic examination indicated that all breast lesions except one, which was a ductal carcinoma in situ, with microinvasion, were infiltrating ductal carcinomas whose size ranged from microscopic to greater than 3 cm. At the time of this study, all seven patients were alive and well, having been disease free for up to 61 months after surgery.

Conclusion

In women with a palpable axillary mass confirmed as metastatic adenocarcinoma, breast sonography may be a valuable adjunct to mammography.     

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。     

卵圆细胞参与实验性肝癌形成过程的研究

目的探讨卵圆细胞在肝组织内的起源及其与原发性肝细胞肝癌的关系。方法清洁型SD大鼠60只,随机分为正常组(20只)和实验组(40只),各组于开始制造肝癌模型后的不同时段取肝组织标本进行常规病理和C-kit、PCNA免疫组化检测。结果正常组大鼠肝脏表面光滑,组织学形态正常,偶见C-kit和PCNA阳性细胞;实验组于肝脏染毒的第2周,首先于汇管区发现卵圆细胞沿胆管上皮依次排列增生,这些卵圆细胞呈C-kit和PCNA阳性表达。随着染毒加重,卵圆细胞以汇管区为中心向肝小叶穿插生长。肝癌形成时,癌结节内外均见有卵圆细胞聚集,此期c-kit阳性细胞仍以汇管区为主,而PCNA阳性细胞遍布癌结节内外。结论卵圆细胞起源于汇管区的胆管上皮;卵圆细胞与肝癌的发生密切相关。     

肝脏恶性肿瘤682例手术治疗分析

目的　探讨影响肝脏恶性肿瘤患者手术治疗后长期生存的因素。方法　回顾性分析1989年 1月至 2 0 0 3年 1月施行外科手术治疗的 6 82例肝脏恶性肿瘤患者的临床资料。结果　小肝癌 (直径 <5cm ,n =2 96 )患者术后 3年、5年生存率分别为 (6 1 2 5± 4 4 1) %和 (5 3 84± 5 6 8) % ,巨大肝癌 (直径 >10cm ,n =14 5 )患者术后 3年、5年生存率分别为 (45 90± 6 98) %和 (30 2 1±10 2 3) % ;肿瘤单发患者 (n =4 0 3)术后 3年、5年生存率分别为 (6 1 86± 3 6 9) %和 (5 5 4 0±4 91) % ,肿瘤多发 (2个或 2个以上 )患者 (n =2 4 6 )术后 3年、5年生存率分别为 (38 31± 4 97) %和(2 8 0 1± 6 31) % ;术前肝功能Child分期为Ⅰ期的患者 (n =397)术后 3年、5年生存率分别为 (6 0 6 8± 3 6 8) %和 (5 0 99± 5 10 ) % ,Ⅱ期或Ⅱ期以上的患者 (n =2 85 )术后 3年、5年生存率则为 (43 0 1±5 33) %和 (36 39± 7 5 8) % ;行局部或一段切除的患者 (n =2 98)术后 3年、5年生存率分别为 (6 8 6 5± 4 95 ) %和 (6 5 38± 5 6 9) % ,行两段或两段以上及半肝切除的患者 (n =32 4 )术后 3年、5年生存率分别为 (49 88± 4 13) %和 (37 98± 5 70 ) %。结论　小肝癌     

原发性甲状旁腺功能亢进症的外科治疗

目的　总结原发性甲状旁腺功能亢进症的外科治疗经验。方法　回顾性分析 1985～2 0 0 2年在我科行外科手术治疗的 5 5例原发性甲状旁腺功能亢进症患者的临床资料。全组病例均行甲状旁腺切除术。结果　 5 5例患者中无症状者 8例 ,骨、关节病变 2 4例 ,泌尿系结石病变 10例 ,骨和泌尿系结石病变 13例 ,病理性骨折 16例。全组血钙均升高 ,在 2 7～ 3 9mmol/L之间 ,平均 (3 1± 0 4 )mmol/L。 5 0例患者术前测定甲状旁腺激素升高在 10 2～ 2 0 0 0pg/ml之间 ,平均 (489 2±6 9 2 ) pg/ml。联合B超、CT、核素扫描术前定位诊断率达 90 9%。术后全组均随访 6个月～ 2年 ,术后临床表现缓解 ,骨质疏松改善 ,骨折愈合 ,有 39例患者出现短期低血钙 ,37例出现面部、手足麻木 ,10例出现手足抽搐。术后有 15例患者血钙正常 ,1例略高于正常值 ,低血钙者经骨化三醇和钙剂治疗 1～ 3周均可改善 ,血钙恢复正常。术后 4 7例患者甲状旁腺激素均在 2个月内恢复到正常 ,3例略高于正常值。结论　甲状旁腺切除术是治疗原发性甲状旁腺功能亢进症的有效方法。经术前影像学定位后行小范围、小创伤的甲状旁腺切除术是可行的手术方法。及时将原发性甲状旁腺功能亢进症患者转入内分泌外科治疗可达到早期治疗、减少骨关节和泌     

游离PSA与总PSA比值在前列腺癌鉴别诊断中的意义

目的　探讨游离前列腺特异性抗原 (fPSA)与总前列腺特异性抗原 (tPSA)比值 (f tPSA)在tPSA为 4～ 10ng ml时对前列腺癌和良性前列腺增生 (BPH)鉴别的意义及其局限性。方法　对1998年 10月至 2 0 0 2年 10月接受诊治的 180例血清tPSA为 4～ 10ng ml的前列腺癌和BPH患者进行回顾性分析。经组织学证实 ,36例 (2 0 % )是前列腺癌 ,14 4例 (80 % )是BPH。血清中tPSA和fPSA通过酶免微粒子捕捉法测定。前列腺体积通过经腹壁超声测定。前列腺癌与BPH组间比较用t检验。采用Pearson相关系数分析前列腺体积与f tPSA之间的相关性。结果　前列腺癌患者的tPSA、f tPSA平均值分别是 6 75ng ml与 0 17;BPH患者则是 6 4 8ng ml和 0 2 5。两组患者的tPSA差异无显著意义 (P >0 0 5 ) ,而前列腺癌患者的f tPSA值显著低于BPH患者 (P <0 0 1)。此外 ,两组患者的前列腺体积与f tPSA均呈显著正相关 (前列腺癌组相关系数r=0 5 0 ,P <0 0 1;BPH组r=0 2 4 ,P <0 0 1)。在前列腺体积小于 4 0cm3,两组患者的f tPSA差异有显著意义 (P <0 0 5 ) ,当体积超过 4 0cm3,则差异无显著意义 (P >0 0 5 )。结论　f tPSA对tPSA在 4～ 10ng ml之间的前列腺癌和BPH的鉴别诊断有重要意义 ,但由于受前列腺体积的影响 ,只有在     

乳晕真皮内注射蓝色染料法前哨淋巴结活检的应用

目的 探讨使用乳晕真皮内注射蓝色染料法前哨淋巴结活检在早期乳腺癌治疗中的作用和价值。方法 回顾性分析25例早期乳腺癌患者应用乳晕真皮内注射蓝色染料法前哨淋巴结活检的临床结果。结果 25例患者中成功检测出前哨淋巴结者24例,检出率为96．0％。共检出前哨淋巴结62枚,平均每例2．5枚。病理结果中HE染色5例淋巴结有转移,免疫组化染色7例阳性。本组前哨淋巴结检出的灵敏度为87．5％;准确性96．0％;假阴性率12．5％;假阳性率0。结论 应用乳晕真皮内注射蓝色染料法前哨淋巴结活检在早期乳腺癌治疗中同样可以取得较高的检出率和准确性。     

甲状腺乳头状癌Ⅵ区淋巴结的归属

目的 评价临床颈侧区淋巴结阴性(cN0)的甲状腺乳头状癌(PTC)患者行选择性颈侧淋巴结清扫的价值。方法 通过分析139例PTC患者(初治时为cN0)的复发和(或)转移部位(甲状腺,Ⅵ区,颈侧区,远处),把Ⅵ区淋巴结转移归入原发灶复发,明确与颈侧区淋巴结转移的区分,逆向分析评价cN0 PTC患者选择性颈侧清扫的临床价值。结果 PTC患者甲状腺复发83％(73／88),Ⅵ区转移76％(67／88),17例为已作选择性颈侧淋巴结清扫,占65％(17／26)。颈侧区淋巴结转移为17％(17／98),其中5例发生于已作选择性颈侧淋巴结清扫,占19％(5／26)。结论 支持对cN0 PTC患者行患侧腺叶切除加Ⅵ区清扫,不支持颈侧区(Ⅱ-V)的选择性颈侧淋巴结清扫。而对初治时为cN0,但术前超声和CT为N 的患者,则支持行颈侧区淋巴结的选择性清扫。在甲状腺癌诊治中,CT检查是必要的。     

脂质体生存素反义寡核苷酸抑制胃癌裸鼠皮下移植瘤生长的作用

目的探讨脂质体生存素反义寡核苷酸(ASODN)对人胃癌裸鼠皮下移植瘤生长的抑制作用及机理。方法将24只裸鼠建立人胃癌细胞系HS-746T皮下移植瘤模型,用不同的转染液处理后随机分成6组：空白对照组,脂质体组,正义链组,100、200和400nmol／L反义链组(ASODN组)。于注射相应试剂后2,4,8,12,16,20d观测裸鼠移植瘤体积,计算抑瘤率和肿瘤缩小率,观察移植瘤细胞形态变化,免疫组化SP法检测生存素的表达,并用逆转录聚合酶链反应技术(RT—PCR)和Western blot蛋白免疫印迹法比较治疗后不同时间各组肿瘤组织中生存素mRNA和蛋白表达的变化。结果注射后20d空白组、脂质体组和正义链组裸鼠的抑瘤率无明显差异,而ASODN组移植瘤的体积随着时间和浓度的增加而减小,肿瘤缩小率则增大,抑瘤率均大于对照组,400nmol／LASODN组抑瘤率最大为93％。光镜下见ASODN组移植瘤凋亡细胞数增多,生存素表达减弱,6例(6／12)肿瘤组织有坏死液化灶。各ASODN组均能够下调移植瘤细胞生存素mRNA含量,抑制生存素蛋白表达,注射20d后400nmol／L ASODN组蛋白表达为空白对照组的36．8％。结论生存素基因反义寡核苷酸能够通过诱导人胃癌裸鼠皮下移植瘤细胞凋亡,下调生存素mRNA和蛋白的表达,抑制裸鼠皮下移植瘤的生长。