垂体腺瘤手术入路选择探讨

目的；更科学更合理地选用垂体瘤切除术式。方法：分别经颅、经蝶垂体腺瘤切除术，比较各入路及优缺点。结果：经颅垂体瘤切除者平均住院日为19d，平均费用为9600元／例，术后并发症多；经口－鼻－蝶入路手术病人平均住院日为14d，费用7000元／例，无并发症。结论：经蝶行垂腺瘤切除术具有适应证广，内分泌紊乱纠正较完全，视力改善理想，并发症少，费用低等优势。     

Simultaneous Expression of Type IX Collagen and an Inhibin-related Antigen in Proliferative Myoepithelial Cells with Pleomorphic Adenoma of Canine Mammary Glands

To identify an alcian blue-positive component expressed in the early stage of mammary mixed tumor and to pursue the possible involvement of a tumorigenic inducing factor, monoclonal antibodies to type IX collagen were generated and used to investigate the immnnohistochemical kinetics of type IX collagen expression by the myoepithelial cell-derived chondrocyte-Uke cells during the development of chondrometaplasia. We also examined the expression of inhibin-related antigen using antibodies to a synthetic peptide spanning amino acids 1–30 of the inhibin α chain. At the earliest stage of chondrometaplasia, where myoepithelial cells began to proliferate inside the basement membrane, the cells expressed type IX collagen together with an inhibin-related antigen which was immunoreactive with the anti-inhibin peptide antibodies. The expression of the inhibin-related antigen was also demonstrated in normal embryonic chondrocytes and myoblasts, but was much less strong in mature chondrocytes and myotubes, strongly suggesting that the inhibin-related antigen is involved in the development of chondrocytes and myoblasts from undifferentiated mesenchymal cells as well as proliferating myoepithelial cells as a chondro-progenitor cell in the mammary mixed tumor. The pathophysiological significance of type IX collagen expression as a possible cell marker of the progenitor cell in myoepithelial cell-related chondrometaplasia is also discussed.     

Papillary adenoma of the prostatic urethra: Report of two cases

Papillary adenoma of the prostatic urethra is a rare cause of hematuria, hemospermia and lower urinary tract obstruction, especially in young adults. We report two cases of papillary adenoma and their endoscopic views. One of the patients had a lesion located on the verumontanum and presented with hematuria, hemospermia and symptoms of lower urinary tract obstruction. The other patient had papillary lesions located in the paramontanal gutter and presented with persistent painless hematuria. The origin of both lesions was proven to be prostatic epithelial differentiation using immunohistochemical identification of prostate-specific antigen. Papillary adenoma is believed to be benign, therefore, both lesions were carefully excised and fulgurated transurethrally.     

应用镍钛记忆合金加压吻合夹进行结肠吻合的临床研究

目的评价一种新型的镍钛记忆合金加压吻合夹（CAC）进行结肠吻合的安全性及有效性。方法2005年4月至2006年2月，南京军区南京总医院将30例结肠癌病人随机分为两组，各15例。研究组使用CAC进行结肠吻合，对照组使用常规吻合器进行结肠吻合。术后观察有无发生与吻合相关的并发症，肠道排气、排便时间，CAC的排出时间。结果两组术后均无吻合口瘘、吻合口狭窄或梗阻等并发症发生。术后肠道排气、排便时间无差异。研究组CAC于术后8～14d均排出体外。结论应用CAC进行结肠吻合安全可靠．使用简便。     

Quantification of the colonic mucous cell population during protracted stress in rats

The mucins contained in goblet cells of the descending colon of rats were histochemically labelled by Alcian blue pH 2.5 and quantified in an image analyzer (Cortex Controller) in 55 Sprague-Dawley rats. After transportation to the stress laboratory, 25 rats were compelled to swim for two consecutive hours/day either only once (five rats), for one week (five rats), two weeks (five rats), four weeks (five rats) or eight weeks (five rats). Twenty-five additional rats were only transported to the stress laboratory (i.e. ‘sham-handled’) controls, either once (five rats), one week (five rats), two weeks (five rats), four weeks (five rats) or eight weeks (five rats). The remaining five rats were ‘untransported’ resting rats (i.e. day 0). The results were expressed in per cent of Alcian blue stain cells/total mucosa analyse. When various time intervals were compared with those of day 0 (i.e. horizontal study) it was found that two hours and one, two weeks swimming resulted in a significantly decreased percentage of mucin-containing cells (p < 0.001). Contrariwise, a significantly increased mucous-cell population was found after eight weeks swimming. ‘Shamhandled’ rats had at two and eight weeks a significantly increased (p < 0.001) percentage of mucous-producing cells. Swimming and ‘sham-handled’ controls were compared at each time interval (i.e. vertical study). The results indicated that swimming rats had a significantly lower (p < 0.001) percentage of mucin-containing cells than transported rats had at day 1 and at one, two and eight weeks. It is concluded that during the first two weeks of daily physical stress, the mucin-cell population of the descending colon of the rat is reduced. This is followed by a hyperproduction of mucin-containing cells. A similar hyperproduction was found at 8 weeks in control rats, suggesting that the mucin-cell population may be altered even in the absence of physical stress. The possibility that protracted transportation acted as a psychical stress in our control rats should be considered.     

Trans-nasosphenoid pituitary adenoma microsurgery in 100 cases

The rhinologist participating in microsurgery of the pituitary adenomaplays an important role in relieving the patients from suffering and indecreasing the incidence of complications.This paper summarily reportsrhinological aspects in 100 cases undergoing trans-nasosphenoid intrasellarmicrosurgery,including operative routes and incisions,methods for opening andreconstructing the sellar floor and nasal comPlications.The authors suggest aseptavestibular incision to modify Hirsch's septal incision,and outline our fivemethods to open and reconstruct the sellar floor.The operator should select themost proper method according to different situations,in operation.The most dan-gerous complications are CSF rhinorrhea with supurative meningitis and fatalhemorrhage.In our experience five such cases were cured by medical and surgicaltreatments.     

204例大肠息肉的免疫组织化学研究

本文采用4种抗结肠癌单克隆抗体CL-2、CL-4、MC_3和MC_5检测了204例大肠息肉。结果显示,4种抗体的相应抗原在正常大肠粘膜为阴性表达,在炎性与幼年性息肉以及单纯性腺瘤阳性表达低,而在腺瘤不典型增生和腺癌癌变阳性表达较高,提示其阳性率与不典型增生有关(P<0.01),4种抗体的相应抗原在大肠癌组织中占优势,且对判定癌前病变的抗原表达有一定的价值,可作为早期判断腺瘤癌变的参考。     

Primary adrenocortical tumors in autopsy records —A survey of “cumulative reports in Japan” from 1973 to 1984—

All cases of primary adrenocortical tumors, including those found incidentally, recorded in the Pathological Autopsy Case Annuals of Japan during a 12 year period from 1973 to 1984 were surveyed. Age- and sex-specific incidences of lesions were estimated from the population, mortality and autopsy statistics for the same period. There were 101 adenomas, 77 of which were presumed to be non-functional, and 222 carcinomas. The age-specific distribution profiles of both the benign and malignant tumors showed single peaks in the sixties and could not be distinguished from one another. The estimated age-specific distribution of morbidity of the non-functional adenomas showed a peak at about 10 years younger than that found in the autopsy records, although it was again similar to that of carcinoma derived from various clinical reports. The morbidity of the non-functional adenomas per 100,000 population was almost equal to that of breast cancer in Japan, being highest in the fifties age group with more than 4,000 people a year being suggested to have adenoma in this age bracket.     

Kraske后入路直肠腺瘤切除术

目的　探讨Kraske后入路局部切除中低位直肠腺瘤的适应证及优缺点。方法　回顾分析 8例距肛门 5～ 10cm直肠腺瘤的手术治疗及术后随访结果 :结果　 8例腺瘤切除彻底 ,近期无局部复发征象。 3例 (37.5 % )术后并发粪瘘 ,1～ 3月后痊愈。结论　Kraske后入路局部切除中低位直肠腺瘤具有损伤小、显露良好、操作简便、病灶清除彻底的优点 ,值得临床推广运用。     

Visual parameters in patients with pituitary adenoma before and after transsphenoidal surgery

Eighty-two patients with pituitary adenoma who underwent transsphenoidal surgery were examined before and after surgery. Nineteen patients had a normal preoperative neuro-ophthalmological examination. All of these patients maintained normal visual parameters postoperatively. The remaining 63 patients had tumour-related loss of visual acuity, visual field, or both. These patients ranged in age from 18 to 78 years. Duration of symptoms ranged from one day to ten years, with a median of six months. Preoperative visual acuity was 6/12 or better in 72% of eyes, with 90% of patients having 6/12 or better in their better eye. Only 7% of eyes had a normal preoperative visual field. Both visual acuity and visual field improved postoperatively in the majority of eyes. In eyes that were examined within one week after surgery and subsequently, substantial improvement occurred within the first postoperative week, but further improvement continued over weeks to months postoperatively, with visual field taking longer to stabilise than visual acuity. Visual acuity at last examination was 6/12 or better in 87% of eyes, and visual field at last examination was normal in 50% of eyes. A total of 92% of patients had visual acuity of 6/12 or better in their better eye, and 62% of patients had a normal visual field in their better eye. Visual acuity at last examination was correlated with both age and preoperative visual acuity. Last visual field also was correlated with both age and preoperative visual field. Patients with preoperative optic atrophy had a poorer visual prognosis than did patients with normal fundi.