乳腺良恶性病变中纤维连接蛋白的分布

目的观察乳腺良恶性病变中纤维连接蛋白（ＦＮ）的分布,探讨它与乳腺癌分化、浸润、转移的关系。方法应用免疫组织化学方法,对乳腺良恶性病变纤维连接蛋白进行半定量研究。结果乳腺癌及淋巴结转移细胞ＦＮ呈强阳性表达,而基膜ＦＮ及间质ＦＮ普遍减少甚至缺乏。结论细胞ＦＮ可能是乳腺癌的一个标记物,间质ＦＮ及基膜ＦＮ减少有利于乳腺癌浸润、转移。     

MR imaging of the male pelvis

Prostate and urinary bladder cancer are the most frequently encountered malignancies of the urinary tract. Appropriate use of the different imaging techniques is crucial for accurate assessment of prognosis and for the development of appropriate treatment planning. Especially determination of local tumor extension and detection of nodal or bone metastases is extremely important. In this regard MR imaging is the most promising imaging technique. Therefore, in this review its role in staging these malignancies is evaluated and compared with clinical staging, and other imaging techniques. Finally, future developments, such as new sequences, new contrast agents, the role of surface coils and MR-guided biopsy, are considered. Also, the preferred radiological approach is discussed.     

MR imaging of the chest: Mediastinum and chest wall

This review presents the options and limitations of MRI in non-vascular diseases of the mediastinum and the chest wall. In numerous thoracic pathologies, MRI is a useful supplement to spiral CT. This imaging procedure also allows a contrast-media-free differentiation of solid tumors and vascular lesions (e. g., aortic aneurysms). The advantages of MRI over CT are particularly useful when multiplanar tumor imaging is required prior to surgery to establish the exact spatial relationship between tumor and the other mediastinal structures. Primary indications for MRI in diseases of the mediastinum and chest wall are therefore: (a) tumors of the posterior mediastinum for determining their position in relation to the neural foramina and the spinal canal; (b) chest wall tumors; (c) preoperative multiplanar imaging of primary mediastinal tumors; and (d) contraindications against CT exams with iodine contrast media.     

Molecular diagnosis of exocrine pancreatic cancer using a percutaneous technique

Background: The K-ras oncogene is activated by point mutations at codon 12 in most patients with exocrine pancreatic cancer. Mutant-enriched polymerase chain reaction (PCR) amplification can enhance the detection of mutated K-ras. This technique was applied to patients undergoing percutaneous fine-needle aspiration (FNA) biopsy of suspect pancreatic lesions. Methods: Twenty-five patients underwent percutaneous FNA of the pancreas for cytologic and molecular analysis. After preparing cytologic smears, the 22-gauge needle and syringe used for FNA were rinsed in RPMI-1640. The specimen was centrifuged, and DNA was extracted from the supernatant and subjected to mutant-enriched PCR using appropriate mismatched primers that introduce a BstNI restriction endonuclease cleavage site at codon 12 of wild-type, but not mutant, K-ras. After digestion with BstNI, the DNA was reamplified. To increase assay sensitivity, the final five PCR cycles were completed incorporating 5 μCi of (α-32P)dCTP. The DNA was then redigested and subjected to gel electrophoresis and autoradiography. Results: The median amount of DNA retrieved per specimen was 3.33 μg. Mutant K-ras was detected as a band of 143 bps; residual wild-type DNA was seen as a 114-bp fragment. Twenty-one of 25 specimens demonstrated mutated K-ras DNA. Two patients with nondiagnostic cytology results had mutated K-ras DNA; adenocarcinoma of pancreatic origin was confirmed in both cases after pancreatectomy. Conclusion: The molecular diagnosis of pancreatic cancer through identification of mutations in K-ras can be readily performed on specimens obtained by percutaneous FNA. As aggressive multimodality management of this disease becomes more common, pretreatment analysis of molecular determinants may have greater clinical significance. Presented at the 48th Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

喉鳞状细胞癌组织体外原代培养的初步研究

目的 应用体外培养技术,对喉鳞状细胞癌组织进行体外培养,探讨喉鳞癌组织原代培养中的各种影响因素,为建立人喉鳞癌组织的细胞系提供实验基础。方法采用体外组织培养技术,对24例人喉鳞状细胞癌组织进行原代培养,观察原代培养中肿瘤细胞的生长与供体的年龄、肿瘤组织的分化程度及不同培养方法的关系,分析在人喉鳞癌细胞的培养中成纤维细胞、微生物污染的影响。结果 24例人喉鳞状细胞癌组织标本,年龄小于60岁组的细胞生长率为31.25％(5/16例),年龄大于60岁组为37.5％(3/8例);高分化组为100％(2/2例),中分化组为30.8％(4/13例),低分化组25％(2/8例);组织块培养法为43.75％(7/16例),酶消化法培养为10％(1/10例);倒置显微镜下观察,在培养的第5～7天,在贴壁组织块周围可见到有上皮样细胞爬出。全部标本中,成纤维细胞的过度生长和微生物的污染是阻碍人喉鳞癌细胞生长的重要因素。结论培养组织的细胞生长率与供体的年龄关系不大;肿瘤组织的分化程度较高者,细胞的生长率较高;与酶消化分离培养法相比,贴壁组织块培养法的细胞生长率较高;成纤维细胞及微生物的污染是阻碍人喉鳞癌细胞系建立的重要因素。     

舌及口底鳞癌治疗分析

目的 探讨舌及口底鳞癌淋巴转移的手术时机与方式对预后的影响。方法 舌及口底鳞癌67例,非手术组12例(为cN_(2～3)患者),手术组55例。cN_028例行原发灶切除,其中23例行选择性颈淋巴清扫。27例cN_(1～3)(cN15例、cN_(2～3)22例)行原发灶切除加根治性颈淋巴清扫,其中16例cN_(2～3)行岛状肌皮瓣修复术:结果 在34例患者中(cN_(2～3)),手术组5年生存率为54.55％(12/22),非手术组5年生存率为41.67％(5/12)。28例cN_0患者中,4例单纯癌肿切除者术后45～60天出现淋巴转移;23例行选择性颈淋巴结清扫术者,证实13例有隐匿性淋巴结转移,10例未见淋巴结转移。结论 对cN_0患者应尽早行选择性颈淋巴结清扫术。对多区域淋巴结或一个区域多个淋巴结转移的cN_(2～3)患者,手术比非手术组的生存率更高,但后者对提高5年生存质量有一定作用。     

枕下-颞下联合入路颞骨良性肿瘤切除术-附3例报告

目的:介绍枕下-颞下联合入路切除颞骨良性肿瘤的方法及体会。方法:对3例颞枕骨化纤维瘤、颞骨纤维异常增殖症、颞骨血管瘤的巨大颞骨良性肿瘤,均采用枕下-颞下联合入路(倒钩形切口)。辅以显微外科技术进行手术摘除肿瘤。结果:3例均基本完整切除肿瘤,无颅内外感染、脑脊液漏、迷路及颅神经损伤等并发症,经术后随访1.5年～2年未发现肿瘤复发。结论:采用枕下-颞下联合入路切除颞枕骨良性肿瘤可获理想的暴露,最大范围切除肿瘤,可避免损伤毗邻的颅神经、血管以及内耳结构,值得推广。     

高温热疗加放射粒子植入及化疗治疗转移性盆腔肿瘤

目的观察高温热疗加放射粒子植入及化疗治疗转移性盆腔肿瘤的疗效.方法将转移性盆腔肿瘤患者分为A、B两组,A组19例,B组22例.A组给予射频加热的同时从电极处灌注2.5%的盐水以扩大肿瘤凝固性坏死的范围.不能热疗的肿瘤边缘组织内植入碘-125粒子.术后第15天开始化疗.奥沙利铂100 mg/m2,静脉滴注,第1天;CF 200 mg/m2,在5-Fu滴注前经静脉滴注2 h,继以5-Fu 200 mg/m2经静脉推注,5-Fu 400 mg/m2经静脉滴注22 h,连续5 d,3周为1周期.B组只给予化疗,化疗用药、剂量及天数与A组相同.结果第6个周期末,A组与B组的有效率分别为84.2%和36.4%,两组有效率比较差异有显著性(P＜0.01).两组的毒副反应发生率差异无显著性.结论高温热疗加放射粒子植入及化疗治疗转移性盆腔肿瘤的近期疗效好,并发症少.     

纤维喉镜与核磁共振（MRI）在喉癌诊断中的应用

将２５例喉癌的术前纤维喉镜检查和喉部ＭＲＩ与手术、病理进行比较，结果提示：纤维喉镜是喉癌诊断的最基本和最重要手段，能对Ｔ１、Ｔ２声门癌作出准确分期；ＭＲＩ对显示粘膜面肿瘤虽然并不重要，但能准确判断肿瘤对会厌前隙、声门旁隙、喉软骨及喉外的侵犯；两者作用互补，对喉癌的诊断、术前分期及手术方法的选择具有重要意义。     

肿瘤合并颈动脉切除术的探讨

肿瘤固着于颈动脉在临床实践中并非少见，如能将肿瘤与受累动脉一并切除，仍不无救治机会。通过体外或体内对患侧颈动脉压迫训练，促使大脑侧枝循环的建立，并采用脑血管造影或／和经颅多普勒血流检测仪（ＴＣＤ）检测证实合格后，可将肿瘤及受累段颈动脉作整块切除。本文报告１９８７～１９９５年间，我们按上述方法给７位患者施行本术，取得较好的效果，无手术死亡及脑血管并发症。