胃肠道癌患者血清中抗癌胚抗原(CEA)抗体的检测及意义

目的：探讨循环中抗癌胚抗原（ＣＥＡ）特异性抗体的情况，评价ＣＥＡ及抗体的联合检测在胃肠道癌诊断中的作用。方法：用放免法检测血清中 ＣＥＡ含量，用酶联免疫吸附法（ＥＬＩＳＡ）检测抗 ＣＥＡ ＩｇＧ抗体，用竞争抑制法检测抗体的特异性。结果：胃肠道癌患者血清 ＣＥＡ含量升高者（≥１５ ｎｇ／ｍｌ）为 ３０．９％（２１／６８），抗 ＣＥＡ ＩｇＧ抗体阳性者为３５．３％（２４／６８），ＣＦＡ及抗 ＣＥＡ抗体的联合检测可使阳性率提高到５４．３％（３７／６８）；胃肠道良性疾病患者（多发性息肉、溃疡、胰腺炎等）血清ＣＥＡ升高者为３．３％（１／３０），抗 ＣＥＡ　ＩｇＧ抗体阳性者为 ３．３％（１／３０）；健康对照组血清 ＣＥＡ升高者为 ０，抗 ＣＥＡ ＩｇＧ抗体阳性者为 ２．５％（１／４０）。结论：胃肠道癌患者血清中抗癌胚抗原（ＣＥＡ）抗体的检出率较高，这些抗体可作为胃肠道癌的一种肿瘤标志物。     

Generalized AA-amyloidosis in a 58-year-old Caucasian woman with an 18-month history of gastrointestinal tuberculosis

 We report on a 58-year-old Caucasian woman who went to a general practitioner about recurrent abdominal pain, night sweats and weight loss of a few weeks’ duration. Once gynaecological disease had been ruled out, the patient was admitted to hospital with severe abdominal pain and intestinal obstruction and a right-sided hemicolectomy was performed. Following the investigation of osteolytic lumbar vertebrae, 18 months after visiting the general practitioner the patient was finally found to be suffering from generalized AA-amyloidosis secondary to gastrointestinal tuberculosis. This had been misinterpreted as Crohn’s disease. Re-examination of the specimens from the right-sided hemicolectomy demonstrated that scanty deposits of AA-amyloid were present 9 months after the first presentation. AA-amyloid can thus be present in serious inflammatory disease even during the first 9 months after the initial clinical presentation. Received: 23 June 1998 / Accepted: 19 August 1998     

Immunohistochemical distribution of chromogranins A and B and secretogranin II in neuroendocrine tumours of the gastrointestinal tract

The aim of the present study was to investigate immunohistochemically the distribution of chromogranin A, chromogranin B, and secretogranin II in a series of 152 neuroendocrine tumours of the gastrointestinal tract. Tumour tissues from 25 argyrophil gastric carcinoids, 18 gastrin and 5 somatostatin-producing tumours, 4 gangliocytic paragangliomas, 49 classical argentaffin and 2 L cell appendiceal carcinoids, 27 classical ileal carcinoids, 17 rectal carcinoids, and 5 poorly differentiated neuroendocrine tumours of the stomach and rectum were immunostained with antibodies against chromogranin A, chromogranin B, and secretogranin II. Chromogranin A was the major granin expressed in gastric carcinoids and in serotonin-producing carcinoids of the appendix and the ileum. In contrast, strong chromogranin B and secretogranin II immunoreactivity was found in rectal carcinoids, in which chromogranin A was rarely expressed. Since chromogranin A is a widely used marker for neuroendocrine differentiation, it is of diagnostic importance that some gastrin-producing tumours, gangliocytic paragangliomas, poorly differentiated neuroendocrine carcinomas, and appendiceal L cell carcinoids completely lacked chromogranin A positivity. It is concluded that the various neuroendocrine tumours of the gastrointestinal tract show distinctly different patterns of granin expression, probably reflecting their histogenetical origin.     

MUC1/Y基因体外冲击树突状细胞诱导抗瘤免疫反应

目的制备含MUC1/Y cDNA质粒转染的树突状细胞(DC),体外诱导杀伤细胞,研究其治疗消化道肿瘤的效果.方法构建MUC1/Y cDNA真核表达载体pIRES2-EGFP-MUC1/Y、pcDNA3.1-MUC1/Y.以pcDNA3.1-MUC/Y电转染8例HLA-A2(+)消化道肿瘤患者单个核细胞衍生的DC后,与自体T细胞混合培养,诱导CTL(T-pcDAN3.1-MUC1/Y).以SW620细胞[HLA-A2(+)、MUC1/Y(+)]为特异性靶细胞,Raji细胞[HLA-A2(-)、MUC1/Y(-)]和Lovo细胞[HLA-A2(-)、MUC1/Y(+)]为非特异性靶细胞,通过乳酸脱氢酶(LDH)释放实验测定杀伤活性,ELISA法检测基因修饰后DC刺激自体T细胞产生IFN-γ的能力,并以ANNEXIN V-FITC试剂盒检测特异性CTL诱导靶细胞凋亡情况.结果pIRES2-EGFP-MUC1/Y转染效率为8%左右.T-pcDAN3.1-MUC1/Y诱导的杀伤作用显著高于T-pcDNA3.1[pcDNA3.1(+)修饰DC诱导的CTL]和T-IL-2(IL-2刺激外周血单个核细胞产生的CTL),P＜0.05.而且T-pcDNA3.1-MUC1/Y对靶细胞的杀伤和诱导凋亡的能力显著高于对照组.基因修饰后的DC能刺激自体T细胞分泌高水平IFN-γ,与未转染的DC相比具有显著差异(P＜0.05).结论成功构建MUC1/Y全长cDNA真核表达载体.pIRES2-EGFP-MUC1/Y可用于真核细胞转染,通过观察转染效率,易于筛选阳性克隆;经pcDNA3.1-MUC1/Y修饰的DC可有效诱导特异性抗肿瘤免疫应答.     

前路椎体次全切在治疗颈椎后纵韧带骨化中的应用

目的：探讨颈前路椎体次全切治疗颈椎后纵韧带骨化的手术减压范围。方法：采用前路椎体次全切植骨融合术治疗颈椎后纵韧带骨化56例，其中完全切除骨化者47例，用“漂浮法”处理者9例，并针对不同个体及病变特点采用不同的减压范围。结果：54例获得3个月-6a随访，平均28个月。植骨均于术后3-5个月内获得骨性融合。JOA评分由术前8．5分提高到术后14．1，平均改善率74％，优良率80．2％。结论：行椎体次全切术治疗颈椎后纵韧带骨化时应针对不同个体及病变特点采用不同的足够的减压范围，可以减少并发症，并获得较佳的疗效。     

鹅胃肠内分泌细胞的免疫组织化学定位

应用６种胃肠激素抗血清，对鹅胃肠各段的内分泌细胞分布进行了免疫组织化学定位。腺胃显示有较多促胃泌素释放肽和生长抑素细胞。肌胃有较多促胃泌素释放肽、生长抑素和胃泌素细胞，少量胰多肽细胞。幽门部有大量的生长抑素细胞，密集的胃泌素细胞，偶见胰多肽细胞。小肠内有胃泌素、胰多肽和生长抑素细胞，细胞类型和数量由前段向后段逐渐减少。未检出胃动素和抑胃肽细胞。     

Pyogenic granuloma: an unrecognized cause of gastrointestinal bleeding

Pyogenic granuloma is a lobular capillary hemangioma that mostly occurs on the skin, but it is also encountered on the mucosal surface of the oral cavity. Only a few cases in other parts of the digestive tract have been reported in Japanese patients. In this report, two Caucasian patients are described, who presented with gastrointestinal bleeding due to the presence of a pyogenic granuloma. One was located in the distal esophagus and could be treated with local excision and laser-photocoagulation therapy. The other one was located in the small intestine and was removed by surgical resection. Although extremely rare, pyogenic granuloma as a cause of gastrointestinal bleeding needs consideration. The lesion is benign, presumably reactive and can be adequately treated by excision or laser photocoagulation. Immunohistochemistry and/or polymerase chain reaction for herpesvirus 8 can reliably distinguish pyogenic granuloma from Kaposis sarcoma, an important differential diagnosis.     

Non-Hodgkin's lymphomas presenting with gastrointestinal involvement

Summary Between 1978 and 1983 a total of 33 patients with non-Hodgkin's lymphoma (NHL) involving the gastrointestinal tract were seen in our institution. Pathological classification was performed according to Kiel. Low grade NHL was diagnosed in 17, high grade NHL in 16 patients. The most frequent histological entity was lymphoplasmocytoid immunocytoma (11 patients). The most common sites of origin were the stomach (23 patients) and the ileocecal region (6 patients). The majority of patients presented with stage I and II disease (20 of 33 patients). As a rule primary therapy consisted of surgery with curative intent. Most of the patients received additional chemotherapy or radiotherapy. Patients with limited disease and complete tumour resection showed long-term survival from 12+ to 57+ months (mean 32.9+ months). Patients with advanced disease (stage III and IV) and only palliative surgery or with lymphoblastic lymphoma had a probability of survival of less than 12 months.Abbreviations NHL non-Hodgkin's lymphoma - IC lymphoplasmocytoid immunocytoma - CC centrocytic lymphoma - CB/CC centroblastic/centrocytic lymphoma - CB centroblastic lymphoma - IB immunoblastic lymphoma - LB lymphoblastic lymphoma - NWDL nodular well-differentiated lymphocytic lymphoma - NPDL nodular poorly differentiated lymphocytic lymphoma - NM nodular mixed lymphoma - NH nodular histiocytic lymphoma - DWDL diffuse well-differentiated lymphocytic lymphoma - DPDL diffuse poorly differentiated lymphocytic lymphoma - DM diffuse mixed lymphoma - DH diffuse histiocytic lymphoma - DU diffuse undifferentiated lymphoma - CT computerized tomography - GI gastrointestinal     

Dysplasia in the gastrointestinal tract: definition and clinical significance

Summary The term dysplasia is used increasingly in gastrointestinal pathology. Dysplasia denotes an unequivocal neoplastic epithelial alteration without invasive growth and is synonymous with the term intraepithelial neoplasia. Dysplasia is the paradigm of a precancerous lesion. Confusion arises because some pathologists do not use the term in the above-defined sense but to describe regenerative, inflammatory and reactive changes. It is essential to separate these kinds of non-neoplastic epithelial changes from neoplastic dyplasia because the clinical consequences are completely different. The general morphology and the grading of dysplasia are described. Most dysplasias in the gastrointestinal tract are the polypoid lesion; dysplasias in flat mucosa are uncommon. Knowledge of the incidence of dysplasia in the gastrointestinal tract is important for the concept of secondary cancer prevention.