Staging-laparoscopy

Summary. The so-called extended diagnostic laparoscopy (EDL) facilitates the comprehensive exploration of the abdominal cavity, thus improving the precision of the pretherapeutic tumor staging in gastrointestinal malignancies. EDL comprises visual inspection with a specific preparation of all relevant sites, laparoscopic sonography and retrieval of samples for biopsy and cytology. Additional relevant therapeutic information was obtained through EDL in 40.5 % of gastric cancer patients. EDL could be of similar importance for diagnosing esophageal, hepatobiliary and pancreatic malignancies.      

瘤体骨切除灭活再植治疗四肢长骨巨细胞瘤

体内刮除及灭活植骨治疗骨巨细胞瘤（ＧＣＴ）的复发率高。我科从１９８６年６月～１９９６年２月治疗四肢长骨ＧＣＴ２４例。随访１１个月～８年４个月。其中７例采用局部切刮体内灭活植骨和（或）骨水泥充填治疗。结果１例感染，６例复发，１例恶变后死于肺转移。作者自１９９１年１月采用瘤体骨切除，离体灭活再植，与骨残端体内灭活相结合，骨缺损采用自家腓、髂骨移植，Ｌ－梯形加压钢板（Ｌ－ＴＣＰ）或梯形加压钢板（ＴＣＰ）固定治疗１７例，其中１２例保留关节，５例做膝关节融合。本组无菌创口感染１例，１例复发。在保留关节的１２例中９例关节功能恢复优良，１例尚可，２例差。充分说明瘤段骨切除体外灭活再植术疗效确实，复发率低。保留关节术式适于关节破坏较轻（＜＝１／２）者，结合关节残端体内灭活和有效的骨结构重建，有利于恢复关节功能。如关节面累及＞１／２，宜做骨关节端切除，灭活再植，下肢宜做关节融合或人工关节置换术。     

A New Serum Tumor Marker, CAM 123-6, Highly Specific to Pulmonary Adenocarcinoma

KL-6, a circulating mucin-like glycoprotein, is a pulmonary adenocarcinoma-associated antigen and is also regarded as an indicator of disease activity of interstitial pneumonitis. KL-6 has extensive heterogeneous antigenic determinants and consists of multiple heterogeneous antigen molecules. We have searched for circulating KL-6-associated glycoproteins with superior diagnostic value to KL-6 as a tumor marker for pulmonary adenocarcinoma. A new murine monoclonal antibody EH-123 reacting with an asialosugar chain on KL-6 was established. A new KL-6-associated molecule detected by a bimonoclonal bideterminant sandwich assay using the EH-123 antibody as a catcher and horseradish peroxidase-labeled KL-6 as a tracer was designated as CAM 123-6. In 59% (22 of 37) of patients with pulmonary adenocarcinoma, serum levels of CAM 123-6 were abnormally elevated and the positive rate increased with the progression of clinical stage. Elevated levels were not detected in normal individuals or in patients with benign lung diseases, other histologic types of lung cancer, gastric cancer, colon cancer or breast cancer. CAM 123-6 was more specific to pulmonary adenocarcinoma than carcinoembryonic antigen (CEA), but the sensitivity of CAM 123-6 for pulmonary adenocarcinoma was similar to that of CEA. CAM 123-6 is a promising candidate as a serum tumor marker for pulmonary adenocarcinoma.     

Relationship between renal capsular artery feeding and size of VX-2 carcinoma implant in the rabbit kidney

When regional intraarterial infusion is applied in the treatment of malignant tumors it is essential to reach the tumor via all its major feeder vessels. In this study VX-2 carcinoma was implanted into the lower pole of the left kidney in 24 rabbits to investigate whether the renal capsular artery takes part in tumor feeding. The rabbits were divided into four groups that were followed for 8, 10, 12 or 14 days after tumor implantation. At that time the renal artery was ligated close to the kidney and subsequently silicone rubber or barium sulfate/gelatin suspension was injected into the capsular artery. The tissue was cleared, and the tumor carefully removed and examined microscopically for traces of silicone rubber. When barium sulfate had been injected, the kidney was examined radiographically in order to detect possible presence of contrast medium in the tumor. This study revealed no vascular supply to the implanted VX-2 carcinoma from the capsular artery when the tumor was confined intracapsularly, i.e., up to 12 days after tumor implantation in untreated rabbits.This investigation was performed at the Oncological Research Laboratory, Department of Diagnostic Radiology, University of Bergen, Bergen, Norway     

癌胚抗原的测定及意义

癌胚抗原（ｃａｒｃｉｎｏｅｍｂｒｙｏｎｉｃａｎｔｉｇｅｎ，ＣＥＡ）作为肿瘤标志物之一，近年在肿瘤，特别是恶性肿瘤的诊断、监测和判断预后等方面得到了广泛地应用，是较灵敏和可靠的指标．本文就ＣＥＡ的测定、意义及不同标本测定的差别等作一综述     

The value of pretreatment clinical and biochemical parameters in patients with newly diagnosed untreated prostate carcinoma and no indications for bone metastases on the bone scintigram

Between 10% and 25% of patients with newly diagnosed prostate cancer without bone metastases at the time of diagnosis will develop metastases during follow-up. To determine the value of clinical and biochemical parameters for assessment of prognosis at the time of diagnosis, a retrospective study was performed in 124 consecutive patients with newly diagnosed prostate cancer without bone metastases. The mean follow-up was 41 months, during which time 36 patients died and 15 patients developed metastases. Bone scans were classified from 0 (=normal) through 2 (=abnormal, but not typical for metastases) and were correlated with age, alkaline phosphatase (AP), prostate-specific antigen (PSA), tumour grade, T-stage and N-stage. In patients with a class 2 scan, additional roentgenograms and follow-up were used to exclude metastases at initial stage. All parameters, including therapy, were finally correlated with the development of metastases and survival. For survival 38 patients with proven metastases were used as controls. For all parameters tested, no statistically significant differences were found between the three bone scan classifications. The interval between diagnosis and the development of metastases ranged from 12 to 72 months. For the risk of development of metastases only PSA was found to be a significant correlate (P=0.0075). However, when tumour stages were clustered in limited disease (T0–2) and extensive disease (T3–4), the incidence of metastases was significantly higher in patients with extensive disease than in those with limited disease (P=0.0021). Finally, age, PSA and Anderson classification were found to be significant correlates of survival, but in stepwise analysis PSA was selected as the most prognostic variable (P<0.0001). In contrast with a typical pattern of metastases on bone scintigraphy, an abnormal scan (class 1 and 2) at the time of diagnosis is not a poor prognostic parameter of the risk of death. In conclusion, in patients with prostate cancer without bone metastases at the time of diagnosis, pretreatment PSA and tumour stage can be used for the assessment of risk of development of metastases during follow-up and survival. For this purpose, tumour stage should be clustered in limited and extensive disease. Received 14 April and in revised form 9 June 1997     

肿瘤高危人群的流式细胞术、内窥镜和病理检查的对比研究

本文对上消化道肿瘤高发区经初筛的１２０例高危人群粘膜组织做了流式细胞ＤＮＡ含量、内窥镜和组织病理学检查的对比研究。其结果显示的肿瘤阳性检出率分别为２７．５％、６．７％和１４．０％。对内窥镜诊断为不同胃疾病患者的流式细胞术分析发现，流式细胞术阳性检出率，胃癌组为７５．０％，萎缩性胃炎组为２８．３％，浅表性胃炎组为７．１％，正常粘膜组为０％。ＤＩ值均值，炎症组（萎缩性胃炎和浅表性胃炎）患者与正常对照组接近，而癌组则明显升高。增殖指数和Ｓ期细胞比例，从正常对照→浅表性胃炎→萎缩性胃炎→胃癌组，呈递增变化，而且各组间有显著差异。     

胰腺黏液非囊性癌9例临床分析

目的探讨胰腺黏液非囊性癌的组织学特点、生物学特征、治疗方法及预后。方法回顾性分析复旦大学附属中山医院普外科2000~2005年间收治的9例胰腺黏液非囊性癌病人的临床特点、影像学改变、病理学特征、治疗经过及随访资料。9例胰腺黏液非囊性癌病人,男7例,女2例,年龄平均(63·1±8·7)岁。肿瘤位于胰头8例,胰体尾1例。行胰十二指肠切除术8例,其中4例合并扩大淋巴结清扫术,1例行胰体尾切除。结果术后病理报告:瘤体平均4·3cm×4·3cm×4·4cm。镜下见8例胰头肿瘤均侵犯十二指肠,侵犯肠系膜上静脉4例。肿瘤侵犯神经3例,淋巴结转移2例。镜下肿瘤表现明确的间质黏液湖及其上漂浮较少的恶性上皮细胞。随访8例,死亡5例。术后存活5~23个月,平均存活11个月,均死于肿瘤复发和肝转移。结论胰腺黏液非囊性癌应是胰腺恶性肿瘤的一个独立的类型,其生物学特征有待进一步研究。     

全肠外营养对老年晚期消化系统恶性肿瘤病人生存期的影响

目的:评估全肠外营养(TPN)对老年晚期消化系统恶性肿瘤病人生存期的影响。方法:回顾性分析121例老年晚期消化系统恶性肿瘤病人TPN治疗后的生存期。结果:TPN治疗后,患者生存期不同程度延长,为9～126天,平均68.1天,多数在两月左右。结论:TPN可延长老年晚期消化系统恶性肿瘤病人的生存期。     

溴环己胺醇预先给药对大鼠盐酸吸入性肺损伤的作用

目的 观察溴环己胺醇预先给药对大鼠盐酸吸入性肺损伤是否具有保护作用，并探讨其可能机制。方法30只健康 SD 大鼠，随机分成3组，A 组：生理盐水吸入组；B组：稀盐酸吸入组；C组：稀盐酸吸入 溴环己胺醇处理组，每组10只。C 组腹腔注射溴环己胺醇，1次/d，连续3d，A、B 组以等体积生理盐水代替。第3天注药后30min，B、C 组气管注入pH 值为1.25的稀盐酸1.2ml/kg，制成盐酸吸入性肺损伤模型，A 组气管注入生理盐水1.2ml/kg。观察注药后5h 动脉血气、氧合指数(PaO_2/FiO_2)、肺湿/干重比(W/D)、肺组织及血清中肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)水平。结果 与 A 组比较，B、C 组 PaO_2、PaO_2/FiO_2降低(P<0.01)，B、C 组W/D、B 组肺组织 TNF-α、IL-8含量、血清 IL-8浓度升高(P<0.01)。与 B 组比较，C 组 PaO_2、PaO_2/FiO_2升高(P<0.01)，C 组W/D、肺组织TNF-α、IL-8含量及血清 IL-8浓度降低(P<0.01)。结论 溴环己胺醇可能通过抑制 TNF-α、IL-8炎症因子的产生和释放机制对盐酸吸入性损伤肺产生保护作用。