抗血管内皮生长因子发夹状核酶基因抑制卵巢癌移植瘤生长的实验研究

目的 采用抗血管内皮生长因子（VEGF）发夹状核酶基因,阻断卵巢癌中VEGF的自分泌和（或）旁分泌通路,以检测抗VEGF发夹状核酶基因对卵巢癌细胞VEGF表达及其肿瘤生长的影响。方法 采用脂质体介导的方法,将自行设计和构建的抗VEGF发夹状核酶基因真核表达载体转染人卵巢癌细胞SKOV3,采用氨基糖甙庆大霉素（G418）筛选获得阳性克隆;RNA斑点杂交检测核酶基因在卵巢癌细胞中的表达;逆转录-聚合酶链反应（RT-PCR）技术检测转染前后卵巢癌细胞中VEGF的表达;透射电子显微镜观察卵巢癌细胞超微结构改变;观察裸鼠皮下成瘤实验检测转染前后细胞的致瘤能力的变化。结果 转染核酶基因后的卵巢癌细胞VEGFmRNA表达明显降低;透射电子显微镜观察出现凋亡细胞;裸鼠致瘤能力减弱,肿瘤组织中VEGF表达及血管形成减少。结论 抗VEGF发夹状核酶基因可显著抑制卵巢癌细胞VEGF表达,通过减少血管形成抑制肿瘤生长,为进一步开展肿瘤血管靶向基因治疗,提供了实验依据。     

Heterotopic gastric mucosa in a duplicate gallbladder

A 7-year-old girl presented with recurrent acute pancreatitis. Detailed investigations, including endoscopic retrograde cholangiography, suggested a poorly defined biliary tract abnormality. At laparotomy, this was discovered to be a duplicate gallbladder each with a separate cystic duct but contained within a single serosal envelope. Both gallbladders were removed, and histologic examination found the inferior organ to be lined by heterotopic fundic-type gastric mucosa. Despite the absence of any remaining structural biliary abnormality and no evidence of residual ectopic gastric mucosa, the patient experienced a few further episodes of self-limiting mild acute pancreatitis during the following 3 years. The presence of heterotopic gastric mucosa in a duplicate gallbladder has not been described previously.     

囊性听神经瘤的诊断与治疗

目的 总结囊性听神经瘤的临床特点及治疗效果。方法 22例患者术前均应用CT和MRI进行诊断,应用乙状窦后入路手术切除肿瘤。术中证实,术后病理确诊囊性听神经瘤。结果 22例肿瘤全切除18例,术后面神经功能分级：Ⅱ级4例、Ⅲ级7例、Ⅳ级3例、Ⅴ级2例、Ⅵ级2例;次全切除4例,面神经功能Ⅱ级。结论 由于囊性听神经瘤的临床特点及疗效差,应把它作为一种特殊亚型来处理。     

Laparoscopic excision of a triple gallbladder

Triplication of the gallbladder is a rare congenital anomaly of the biliary tract; there are only nine reported cases to date. We report a case in which laparoscopic cholecystectomy was performed in a patient with biliary colic and choledocholithiasis. Preoperative assessment with ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) failed to reveal the eventual findings of a triple gallbladder. Successful excision of the triple gallbladder was carried out laparoscopically, and the final diagnosis was confirmed by the pathologist. The patient made an uneventful postoperative recovery and was free of gastrointestinal symptoms at follow-up. This case report describes the first laparoscopic excision of a triple gallbladder and highlights the importance of pre-/perioperative imaging to allow for the safe dissection of rare anomalies of the biliary tract via the laparoscopic approach.     

Use of multislice helical computed tomography cholangiography in the diagnosis of biliary disease

A recent advance in computed tomography (CT) technology, multislice helical CT, has enabled production of clearer three-dimensional (3D) images and has drawn interest. We report the usefulness of CT cholangiography using a multislice helical CT scanner for the diagnosis and preoperative imaging of the biliary duct in a case of peculiarly shaped gallbladder with cholecystitis. A 34-year-old woman admitted to our hospital presented with chronic hypochondralgia. A CT scan showed that the gallbladder was normal without wall thickening or stones. However, there appeared to be a tumor, containing a stone approximately 1 cm in diameter, attached under the gallbladder in front of the right kidney and extending up to its lower level. Magnetic resonance cholangiography also depicted a normal gallbladder without wall thickening or stones. Hence, gallbladder stones were not diagnosed by previously the mentioned investigations. In contrast, a 3D image produced by multislice helical CT cholangiography was very clear. From the bottom of the gallbladder, a narrow canal continued to a stone. We diagnosed that the wall of the lower part of the long gallbladder had become thick and elongated because of chronic cholecystitis caused by a gallbladder stone, and laparoscopic cholecystectomy was performed. Macroscopically, the resected gallbladder showed an extremely thickened wall from the lower body to the fundus, in which a stone was located in the center. Multislice helical CT cholangiography has the potential to become one of the most significant examinations for diagnosis and anatomical analysis of biliary disease prior to laparoscopic cholecystectomy.     

Dynamic contrast-enhanced MR imaging in monitoring response to isolated limb perfusion in high-grade soft tissue sarcoma: initial results

The objective of this study was to evaluate whether dynamic contrast-enhanced MR imaging can determine tumor response and localize residual viable tumor after isolated limb perfusion (ILP) chemotherapy in soft tissue tumors. Twelve consecutive patients, with histologically proven high-grade soft tissue sarcoma, prospectively underwent non-enhanced MR and dynamic contrast-enhanced MR imaging before and after ILP. Tumor volume was measured on non-enhanced MR images. The temporal change of signal intensity in a region of interest on dynamic contrast-enhanced MR images was plotted against time. Start, pattern, and progression of enhancement were recorded. Histopathologic response was defined as complete response if no residual viable tumor was present, partial remission if <50% viable tumor was present, and no change if ≥50% viable tumor was present in the resection specimen. Resected specimens for correlation with histopathology were available for 10 patients; 5 patients had partial remission and 5 had no change. Volume measurements correctly predicted tumor response in 6 of 10 patients. Dynamic contrast-enhanced MR correctly predicted tumor response in 8 of 10 patients. Early rapidly progressive enhancement correlated histologically with residual viable tumor. Late and gradual, or absence of enhancement, was associated with necrosis, predominantly centrally located, or granulation tissue. These preliminary results show that dynamic contrast-enhanced MR imaging offers potential for non-invasive monitoring of response to isolated limb perfusion in soft tissue sarcomas due to identification of residual areas of viable tumor and subsequently may provide clinically useful information with regards to timing and planning of additional surgery. Further prospective studies in a larger patient population is warranted.     

Lymphoma: pictorial review. I

Lymphoma is a spectrum of malignant neoplasms of the lymphoid system. The appearances radiologically are diverse with almost all organs susceptible to involvement. The condition is challenging as it can mimic the appearance of almost all other neoplasms. This review highlights in a general way the diversity of the radiological appearances and organs involved. Electronic Publication     

放射诱发的第二原发性恶性肿瘤的临床治疗

目的 探索放射诱发的第二原发性恶性肿瘤的临床诊断和治疗。方法 回顾分析108例鼻咽癌患者因放射诱发的第二原发性恶性肿瘤的临床资料。结果 小组108例患者中,鳞状上皮癌43例,占39．8％;肉瘤类26例,占24．1％;恶性纤维组织细胞瘤14例,占13．0%;腺样囊性癌12例,占11．1％;甲状腺乳头状腺癌8例,占7．4％;恶性黑色素瘤5例,占4．6％。手术治疗50例,放射治疗32例,全身化疗18例,诱导化疗并手术治疗8例。手术组3,5年无瘤生存率分别为64．0％和36．0％,放疗组3,5年无瘤生存率分别为34．4％和18．8％。结论 放射诱发的第二原发性恶性肿瘤如具备手术适应证,应首选外科治疗。与治疗第一原发癌一样,积极治疗第二原发性恶性肿瘤同样可以获得较好的治疗效果。     

143例功能性垂体微腺瘤的X-刀治疗分析

背景与目的：长期以来神经外科经蝶入路手术切除是治疗功能性垂体微腺瘤的主要方法之一,近年来由于放射外科技术的发展,给神经外科医生们提供了新的治疗功能性垂体微腺瘤的方法。本研究旨在探讨X—刀放射外科技术治疗功能性垂体微腺瘤效果。方法：1996年6月至2001年6月我们应用X—刀治疗垂体微腺瘤143例,其中泌乳素(Prolactin,PRL)腺瘤73例、生长激素(grouth hormone,GH)腺瘤54例、促肾上腺皮质激素(adrenal conticotropin hormone,ACTH)腺瘤13例、混合性(GH PRL)腺瘤3例。所有病例均为单个等中心单次治疗。结果：X—刀治疗后,随访3—60个月,中位随访时间38．4月。除失访的31例外,随访到的112例患者中,显效78例(69．7％),有效10例(8．9％),无变化19例(16．8％),进展5例(4．6％)。结论：使用X—刀放射外科治疗功能性垂体微腺瘤是一种安全和有效的方法。     

环磷酰胺或足叶乙甙联合粒细胞集落刺激因子动员自体外周血造血干细胞的对照研究

背景与目的:通过动员采集获得高质量的自体外周血造血干细胞(autologousperipheralbloodstemcell,APBSC)是造血干细胞移植成功的关键,环磷酰胺(cyclophosphamide,CTX)联合重组人粒细胞集落刺激因子(recombinedhumangranulocytecolony-stimulatingfactor,rhG-CSF)是APBSC经典的动员方案,足叶乙甙(etoposide,VP-16)联合rhG-CSF是近年来应用的另一个动员方案。本研究的目的是比较上述两种动员方案对恶性淋巴瘤和生殖细胞肿瘤患者APBSC的动员效果。方法:共有52例恶性实体瘤患者,其中CTX方案组26例,剂量为CTX3.5g/m2加rhG-CSF5μg·kg-1·d-1;VP-16方案组26例,VP-16的剂量随机采用1000mg/m2或1500mg/m2加rhG-CSF5μg·kg-1·d-1。两组均在白细胞(whitebloodcell,WBC)降至最低点时开始皮下注射rhG-CSF,直至采集结束前一天。当CTX组WBC恢复到2.5×109/L、VP-16组WBC恢复到5.0×109/L以上时开始连日采集APBSC,当累计采集的单个核细胞(mononuclearcell,MNC)≥5×108/kg或CD34+细胞≥2×106/kg时停止采集。患者经预处理后回输采集到的APBSC。比较两组动员采集过程中的血液学指标变化、采集细胞数量、造血重建时间、不良反应等。结果:CTX组患者化疗后外周血中WBC和血小板(platelet,PLT)降至最低值的时间明显早于VP-