成人肾母细胞瘤的诊断与治疗（附12例报告）

目的探讨成人肾母细胞瘤的诊断和治疗方法。方法回顾性分析12例成人肾母细胞瘤患者的临床资料。结果本组患者年龄16-63岁,表现为肉眼血尿2例,腰腹痛6例,4例为体检发现;术前诊断为肾肿瘤9例,肾盂肿瘤3例。12例均行手术治疗,术后病理均诊断为肾母细胞瘤。按照美国国家肾母细胞瘤研究组（NWTS）分期标准,本组分别为Ⅰ期5例、Ⅱ期3例、Ⅲ期3例、Ⅳ期1例。术后辅以放疗和化疗,平均随访41个月,3年生存率为48%。结论成人肾母细胞瘤是一种比较少见的恶性肿瘤,术前确诊困难,手术治疗并辅以放疗、化疗是其主要的治疗方法。     

Effects of skeletal morbidities on longitudinal patient-reported outcomes and survival in patients with metastatic prostate cancer

Goals of work Patients with prostate cancer metastasized to bone frequently experience skeletal morbidities as a result of their disease. We sought to quantify the longitudinal effects on patient-reported outcomes of skeletal-related events (SREs) and to ascertain the declines in health-related quality of life (HRQOL) and pain experienced by patients who experienced SREs. Materials and methods Data are from a clinical trial for the treatment of SREs associated with advanced prostate cancer metastatic to bone. Outcome measures included the Functional Assessment of Cancer Therapy-General (FACT-G) and the Brief Pain Inventory. Among patients who survived 6 months after randomization, patients with no SREs in the initial 6 months after randomization were matched via propensity scores with those experiencing one or more SREs. Similarly, patients with one SRE were matched with a subset of patients with two or more SREs. Main results Patients with SREs in the initial period had significantly worse survival and HRQOL than those with no SREs. Significant differences were found between the pain differences, FACT-G total scores, and FACT-G physical, emotional, and functional subscales. Comparisons of patients with single vs multiple SREs showed similar patterns. Conclusions The presence of SREs is significantly associated with worse survival and poorer HRQOL in this patient population. Increasing SRE intensity shows a pattern of increasingly decreased survival and poorer HRQOL. Ms DePuy is now with INC Research, Raleigh, NC, USA.     

软组织肿瘤MR弥散加权成像量化研究初探

目的:探讨MR弥散加权成像(DWI)ADC值和EDC在软组织肿瘤定性诊断中的价值。材料和方法:研究了23例软组织肿瘤DWI。DWI采用SE-EPI序列,弥散敏感系数b分别取0、300s/mm²,同时在3个方向施加弥散敏感梯度场,获得其ADC值和EDC值。结果:①在b=300s/mm²时,良性肿瘤组的ADC值为(1.64±0.15)×10^-3mm²/s,恶性肿瘤的ADC值为(1.86±0.19)×10^-3mm²/s,恶性肿瘤组的ADC值大于良性肿瘤的ADC值,良、恶性肿瘤组间的ADC值差异有显著性;②在b=300s/mm²时,良性肿瘤组的EDC值为(136.89±44.60)×10^-3,恶性肿瘤的EDC值为(160.02±83.23)×10^-3,恶性肿瘤组的EDC值大于良性肿瘤的EDC值,良、恶性肿瘤组间的EDC值差异无显著性。结论:在b=300s/mm²时,恶性软组织肿瘤的ADC值大于良性软组织肿瘤的ADC值,良、恶性肿瘤组间的ADC值差异有显著性;恶性肿瘤组的EDC值大于良性肿瘤的EDC值,良、恶性肿瘤组间的EDC值差异无显著性。     

乳腺肉瘤28例诊断治疗分析

为探讨乳腺肉瘤的临床特点和治疗方法,对1972年1月至2006年9月收治的28例乳腺肉瘤的临床资料进行回顾性分析。结果:随访10个月～32年,6例死亡,7例复发。5年生存率为80.3%,10年生存率为71%。该病的诊断需要病理证实。治疗方法以手术治疗为主。对于肿块较小,无淋巴结转移者可行单纯乳房切除;对于有腋窝淋巴结转移者需要行根治术。对局部复发的患者不应放弃再次手术的机会。     

CXCR4和血管内皮生长因子在胆管癌中的表达及其临床意义

摘要: 目的 探讨CXCR4和VEGF 蛋白在肝外胆管癌中的表达相关性及其与胆管癌发展与预后的关系。方法　应用免疫组化技术SP法检测CXCR4和VEGF蛋白在35例胆管癌标本、10例正常胆管的表达。结果　胆管癌组织中CXCR4的阳性表达率为54%(19/35), VEGF 的阳性表达率为76%(27/35) ; 在正常胆管组织中未检测到CXCR4和VEGF 的表达。癌组织中CXCR4和VEGF 蛋白的表达呈正相关( r=0.715,P <0.05 ) 。CXCR4和VEGF 蛋白表达与肿瘤转移与否、复发关系密切, 但与患者的性别、年龄、肿瘤大小及分化无关。结论　CXCR4和VEGF在胆管癌中高表达, 两者表达呈正相关; 与胆管癌的转移与预后关系密切。     

应用FISH技术检测原发性肺癌P^53抑癌基因异常及其临床意义

目的　探讨原发性肺癌 P53缺失 /异常表达及临床意义。方法　应用 FISH和免疫组化技术检测 6 5例肺癌间期核中 P53基因异常。结果　 P53缺失率为 18.4 % (12 / 6 5 ) ,分化好比分化差者缺失率增高 (P=0 .0 0 7)。 P53蛋白阳性率随着肺癌临床分期增高呈上升趋势 (P=0 .0 4 6 ) ,与年龄、性别、肿瘤大小及分化程度等无相关性 (P>0 .0 5 )。结论　 P53基因缺失和蛋白表达与肺癌分化程度、临床分期密切相关 ,检测 P53基因缺失和蛋白表达可作为肺癌病理分级和判断预后的重要指标     

姜建国从厥阴理法辨治PCOS型不孕症经验

运用厥阴理法,从《伤寒论》中汲取中医治疗复杂性疾病的思路,从3个方面总结了姜建国教授辨治PCOS型不孕症的经验。(1)依据厥阴病的特点及其判断标准,从整体上分析PCOS型不孕症临床表现复杂性的特点;(2)参照厥阴病主方乌梅丸组方思路,结合用药经验,灵活加减组方,制定总体治疗方案;(3)倡导立足中医,中西医互参互补,提出少阴肾-厥阴肝-胞宫轴的辨治体系,这一体系不同于常规辨证论治,是一种权变的治疗思路,具有一定临床价值。