联合检测自发凋亡率及p27kip1在膀胱移行细胞癌中的意义

目的探讨自发凋亡率、p27kip1在人膀胱移行细胞癌中表达的临床意义。方法采用TUNEL法检测自发凋亡细胞,用S’P法检测p27kip1基因在50例膀胱移行细胞癌中的表达,分析各检测指标在上述标本中的表达及与膀胱移行细胞癌分级、临床分期间的关系。结果在膀胱移行细胞癌中,自发凋亡率AI均数为(3.0±1.5)%,p27kip1基因的阳性表达率为58.0%(29/50)。其二者的阳性表达均随膀胱癌分级、分期的升高而降低。p27kip1蛋白阳性组中AI均数显著高于p27kip1蛋白阴性组(P<0.05)。结论p27kip1蛋白和自发凋亡率与肿瘤的恶性程度和进展密切相关,联合检测p27kip1和自发凋亡率有助于更准确地解释和描述膀胱癌的生物学行为。     

经尿道膀胱肿瘤切除专用手术刀具的临床应用

目的对经尿道膀胱肿瘤切除专用手术刀具治疗浅表性膀胱肿瘤进行临床应用评价。方法在传统电切刀的远端添加保护襻组成膀胱肿瘤切除专用手术刀具。使用该种手术刀具治疗浅表性膀胱肿瘤48例,使用方法与普通电切刀近似。男26例,女22例。年龄23~76岁,平均43岁。肿瘤分期Tis者1例,T0~T1者47例。肿瘤分级G1~G2者36例,G3~G4者12例。瘤体直径0.5~8.0 cm。肿瘤位于膀胱顶部4例,左侧壁11例,右侧壁9例,前壁4例,后壁13例,颈部7例。肿瘤单发31例,多发17例。术后常规卡介苗膀胱灌注1年,每3个月行膀胱镜检查1次。结果48例平均手术时间(23±10)m in。术中18例(37.5%)发生闭孔神经反射,未出现膀胱穿孔病例;无瘤体后部的正常膀胱黏膜误切。46例术后随访1年,14例复发,均为远位新生膀胱肿瘤,术后3个月时发现1例,4~6个月时3例,7~9个月时6例,10~12个月时4例。结论使用该专用手术刀具治疗浅表性膀胱肿瘤容易控制切除深度,可最大限度地避免膀胱穿孔,并可保护大体积肿瘤后部盲区的正常黏膜以免误切。     

椎管内肿瘤磁共振成像增强扫描初步观察

对１１例手术病理证实的椎管内肿瘤进行磁共振成像（ＭＲＩ）增强扫描的前、后分析，并对肿瘤定位、定性和鉴别诊断作了初步探讨。根据肿瘤形态、边界、强化程度，及与脊髓、硬脊膜、神经根等关系，ＭＲＩ的增强扫描对提高其定位、定性诊断均有较大的帮助。     

Low energy charge and high adenosine content in smooth muscle of human bladder in comparison with striated muscle

Summary This study determined the energy charge, adenosine and inosine content of human bladder smooth muscle in comparison with striated muscle of the same individual. Biopsies were obtained from 21 women who were subjected to urethrocystopexy because of urinary stress incontinence. We found that the ATP content of bladder smooth muscle was only about one-eighth of that of striated muscle. The energy charge of bladder smooth muscle was 0.78±0.13, which is low compared with striated muscle (0.92±0.02). The adenosine content of bladder smooth muscle was 6.7 times higher than striated muscle and the adenosine/ATP ratio was 1∶9 compared with 1∶450 for striated muscle. These findings were in accordance with our previous studies on uterine smooth muscle.     

Fluid-fluid levels in cavernous hemangioma of soft tissue

Five cases of cavernous hemangioma with fluid-fluid levels on magnetic resonance imaging and/or computed tomography are reported. The signal characteristics were those of blood and histological analysis of the fluid-fluid levels showed that they were blood-filled cavities in the tumor. Although this finding itself is not specific, it may help in confirming the diagnosis of cavernous hemangioma.     

膀胱全切非管状乙状结肠膀胱成形术（附六例报告）

对６例多发性浸润性膀胱癌而膀胱颈部及尿道无侵犯的患者在膀胱前列腺全切后以非管状乙状结肠原位代膀胱。经３～２５个月的随访，除１例仍有轻度尿失禁伴轻度排尿困难外，余５例手术后６个月以上者非管状乙状结肠膀胱容量大、压力低，经尿道排尿、排空完全、自控性好，无全身营养障碍及水电酸碱紊乱，节省肠管，手术简便。     

膀胱癌患者血清及尿中L-selectin检测的临床意义

目的　探讨膀胱移行细胞癌 (TCC)患者检测血、尿细胞粘附因子L selectin的临床意义。　方法　采用ELISA法测定 46例膀胱癌患者 (浸润性 2 0例 ,浅表性 2 6例 )及 14例良性前列腺增生患者血清及尿L selectin浓度。　结果　 3组患者术前L selectin血清浓度分别为 :浸润性癌患者 ( 76 6 .3± 135 .1)ng ml,浅表性癌患者 ( 5 6 3.8± 118.2 )ng ml,良性前列腺增生患者 ( 5 44 .1± 12 1.2 )ng ml。浸润性癌组与浅表性癌组及良性增生组分别比较 ,差异有显著性意义 (P <0 .0 1)。浸润性癌患者术后血清L selectin浓度显著低于术前 (P <0 .0 5 )。浸润性癌组术前尿L selectin水平显著高于浅表癌组及良性前列腺增生组 (P <0 .0 1)。　结论　血、尿L selectin浓度水平与TCC浸润程度有关 ,对TCC患者治疗前临床分期及选择手术方案有参考价值。     

兔膀胱出口部分梗阻所致逼尿肌超微结构的改变

目的　观察兔膀胱出口部分梗阻后逼尿肌细胞超微结构的改变。　方法　建立雄性兔膀胱出口部分梗阻动物模型 ,利用透射电镜观察其逼尿肌细胞内超微结构 ,应用ImagineTool图像分析软件检测粗面内质网面积和线粒体密度。　结果　梗阻组逼尿肌细胞内单位面积平均 1 1 5 .2 8μm2 ,胞质中粗面内质网面积 (5 .377± 2 .31 8) μm2 ,较对照组的 (0 .476± 0 .31 9) μm2 明显扩大 ;线粒体相对密度为 1 .0 2 7± 0 .0 64 ,较对照组的 0 .830± 0 .0 58明显下降 ,P均 <0 .0 1。　结论　膀胱出口部分梗阻后逼尿肌细胞内质网扩张 ,提示其合成蛋白质功能增强 ,从而引起膀胱壁增厚 ;而线粒体水肿明显 ,密度下降 ,提示逼尿肌细胞能量代谢障碍 ,导致其收缩功能下降     

Carcinoma of the papilla of vater: Are endoscopic appearance and endoscopic biopsy discordant?

Carcinoma of the papilla of Vater is classified as periampullary cancer representing 5% of all gastrointestinal tract malignancies. Early and accurate diagnosis is important for those patients with a tumor of the papilla, as the prognosis is more favorable than in other periampullary neoplasms. Endoscopically obtained biopsies from suspicious papillae can detect an early tumor, although even for skilled pathologists it is often difficult to differentiate carcinomas from noninvasive lesions on the basis of forceps biopsies. The purpose of this study was to assess the preoperative diagnostic accuracy of duodenoscopy appearance and biopsy in all cases with suspicion of tumor. Thirty patients with suspicion of carcinoma of the papilla of Vater and with final diagnosis established by pancreatoduodenectomy were included in this retrospective study. In each case, a comparison was made between endoscopic biopsy and duodenoscopic appearance. Duodenoscopic appearance sensitivity and accuracy for malignancy were 86% and 83%, respectively, whereas endoscopic biopsy sensitivity and accuracy were 65% and 67%, respectively. Although preoperative diagnosis of carcinoma of the papilla of Vater is useful for making therapeutic decisions, the diagnostic value of the endoscopic appearance was superior to endoscopic biopsy in this series. Presented at the 2003 American Hepato-Pancreato-Biliary Association Congress, Miami, Florida, February 27-March 3, 2003. Supported by FADA-CAPES/PROP 200J (M.L.D.).     

Long-term outcome and complications of children born with meningomyelocele

The long-term functional outcome of 101 children born with meningomyelocele between 1971 and 1981 was assessed, by a combination of retrospective chart review and follow-up assessments. The children had been managed at birth using a process ofnonstandardized selection. Eighty-three of the 101 patients survived after a minimum follow-up of 8.6 years, for a mortality rate of 18%. Forty-four of 83 children (53%) were community ambulators, and this correlated well with the presence of intact quadriceps function. Forty-eight children (58%) attended normal school and were grade-appropriate. Sixty-two of 83 patients (75%) were socially continent of urine, and 71/83 (86%) were socially continent of stool. Hydrocephalus was present in 93 of the 101 children in the study, and 85 children were shunted. Half of the shunted children required a shunt revision in the first year of life, and thereafter the rate of revision decreased, so that after 2 years the risk of revision was approximately 10% per year.