细胞DNA倍体分析与常规细胞学诊断对宫颈上皮内瘤变诊断评估的比较

目的评价采用DNA定量分析方法进行宫颈癌普查的工作效率和准确性。方法对参与宫颈癌普查的3070名妇女用宫颈刷取材,进行液基薄层制片,分别进行巴氏染色和Feulgen染色,由细胞学医师对巴氏染色片做常规细胞学诊断,应用全自动DNA倍体分析对Feulgen染色片进行自动扫描诊断。结果对常规细胞检查结果在不明意义的非典型鳞状上皮（ASCUS）及以上病例和全自动DNA倍体分析系统检查可见异倍体细胞或异倍体细胞峰的病例,建议进一步做阴道镜检查以及宫颈活检。146名妇女做了病理活检。以病理诊断结果为标准,计算常规细胞学诊断和细胞DNA定量分析方法在筛查CINⅡ及以上宫颈病变的敏感性、特异性、阳性预测值、阴性预测值。以〉3个DNA异倍体作为评估CINⅡ及以上病理改变,其敏感性、特异性、阳性预测值、阴性预测值分别是80．95％、57．60％、24．29％、57．60％,除阴性预测值外均比常规细胞检查为低级别鳞状上皮内病变及以上级别评估CINⅡ及以上病理改变标准（分别是76．19％、40．00％、17．58％、90．90％）要高,其他级别中〈3个DNA异倍体与ASCUS、≥10个DNA异倍体与高级别鳞状上皮内病变相应指标比较均高。同时,细胞DNA定量分析图客观准确,不仅能识别宫颈细胞涂片中的大量DNA异倍体,还能识别少量DNA异倍体细胞,对临床工作的指导有较重要的意义。结论细胞DNA定量分析方法能较好地提高宫颈癌普查的阳性检出率。     

Colonoscopic yield of colorectal neoplasia in daily clinical practice

AIM： To assess the prevalence and location of advanced neoplasia in patients undergoing colonoscopy, and to compare the yield per indication. METHODS： In a multicenter colonoscopy survey （n = 18 hospitals） in the Amsterdam area （Northern Holland）, data of all colonoscopies performed during a three month period in 2005 were analyzed. The location and the histological features of all colonic neoplasia were recorded. The prevalence and the distribution of advanced colorectal neoplasia and differences in yield between indication clusters were evaluated. Advanced neoplasm was defined as adenoma 〉 10 mm in size, with 〉 25% villous features or with high-grade dysplasia or cancer. RESULTS： A total of 4623 eligible patients underwent a total colonoscopy. The prevalence of advanced neoplasia was 13%, with 281 （6%） adenocarcinomas and 342 （7%） advanced adenomas. Sixty-seven percent and 33% of advanced neoplasia were located in the distal and proximal colon, respectively. Of all patients with right-sided advanced neoplasia （n = 228）, 51% had a normal distal colon, whereas 27% had a synchronous distal adenoma. Ten percent of all colonoscopies were performed in asymptomatic patients, 7% of whom had advanced neoplasia. In the respective procedure indication clusters, the prevalence of rightsided advanced neoplasia ranged from 11%-57%. CONCLUSION： One out of every 7-8 colonoscopies yielded an advanced colorectal neoplasm. Colonoscopy is warranted for the evaluation of both symptomatic and asymptomatic patients.     

Embolization as an Alternative Treatment of Insulinoma in a Patient with Multiple Endocrine Neoplasia Type 1 Syndrome

Insulinoma is a rare neuroendocrine tumor, most commonly originating from the pancreas, which is either sporadic or familial as a component of multiple endocrine neoplasia type 1 syndrome (MEN1). It is characterized by increased insulin secretion leading to hypoglycemia. Surgical removal is considered the treatment of choice, with limited side effects and relatively low morbidity and mortality, both being improved by the laparoscopic procedure. We present the case of a 30-year-old patient with MEN1 and recurrent insulinoma with severe hypoglycemic episodes who could not be surgically treated due to the adherence of the tumor to large blood vessels and to prior multiple surgical operations. He was treated by repeated embolization using spherical polyvinyl alcohol particles, resulting in shrinkage of the tumor, improvement of the frequency and severity of the hypoglycemic episodes, and better quality of life.     

北方食管癌高发区食管和食管-胃交界部低级别内瘤变队列随访

目的:食管和贲门上皮不典型增生是癌前病变,分为轻度,中度和重度三个级别.2000年WHO建议用上皮内瘤变取代不典型增生,将轻度和中度归为低级别内瘤变,并将贲门腺癌称为食管-胃交界腺癌.本文探讨食管癌高发区食管和食管-胃交界部低级别上皮内瘤变癌变危险性和时间演变规律,为食管癌二级预防提供科学数据.方法:选择磁县2个乡于2001年10月～2002年10月,开展内镜碘染色队列筛查,干预乡0～85岁总人口数为22 016例,其中40～69岁共计6 596例,男性3 257例,女性3 339例,除去禁忌症、外出打工、拒绝参加者外,实际内镜筛查3 506例,筛查率53.2%.病理以WHO诊断为标准,将食管鳞状上皮轻度和中度不典型增生及食管-胃交界部轻度不典型增生划为低级别内瘤变人群,共诊断616例;内镜筛查无癌前病变和非癌诊断的作为正常人群共2478例.2008年6～9月对该队列人群进行随访核实.其中有174例失访,随访率95.0%.结果:低级别内瘤变人群和内镜病理正常人群随访分别为3 970.7人·年和16 120.0人·年,低级别内瘤变人群癌变率251.7/10万人·年,正常人群68.2/10万人·年;中位癌变时间分别是38个月和47个月.与正常人群比较,LIN癌变相对危险度RR=3.69(1.57～8.69),P=0.001.结论:低级别内瘤变人群是一组高危险人群,每年内镜复查是必要的.     

An association between invasive breast cancer and familial idiopathic hyperparathyroidism: a case series and review of the literature

The possibility of an association between primary hyperparathyroidism and breast cancer has been postulated. We report here a sibship with three premenopausal breast cancers and hyperparathyroidism, and no detectable BRCA or MEN1 gene mutations. We explore genetic and molecular rationales for an association between these metabolic and neoplastic processes.     

端粒酶在宫颈癌及其癌前病变组织中的表达及意义

目的探讨端粒酶在宫颈癌及癌前病变组织中的表达及其在宫颈癌发生、发展过程中的作用。方法采用免疫组织化学EnVision二步法,检测30例浸润性宫颈癌（ICC）、90例宫颈上皮内瘤变（CIN）和10例正常宫颈组织标本中端粒酶的表达。结果端粒酶在正常宫颈组织、CINⅠ、CINⅡ、CINⅢ及浸润性宫颈癌中的阳性表达率分别为30.0%、40.0%、43.3%、70.0%和93.3%。端粒酶表达率浸润性宫颈癌高于CINⅢ,CINⅢ高于CINⅡ,差异均有统计学意义（P〈0.05）;CINⅡ与CINⅠ,CINⅠ与正常宫颈组织比较,差异均无统计学意义（P〉0.05）。结论端粒酶的表达与宫颈癌的发生、发展密切相关。端粒酶可作为宫颈癌癌前病变转归的预测指标。     

Current management of medullary thyroid cancer

Medullary thyroid cancer accounts for 5%-10% of all thyroid cancers. The majority of medullary thyroid cancers are sporadic, but 20% of cases are a result of a germline mutation in the ret proto-oncogene. Hereditary medullary thyroid cancer can be seen as part of the multiple endocrine neoplasia syndrome type 2A or 2B or as part of familial medullary thyroid cancer. This article discusses the current methods available for the diagnosis and evaluation of a patient with suspected medullary thyroid cancer. The management of medullary thyroid cancer is predominantly surgical excision, consisting of a total thyroidectomy and lymph node dissection. The extent and timing of surgical excision are discussed. Systemic therapeutic options are limited for medullary thyroid cancer, but several therapeutic targets show promise for the development of new therapies in the future.     

Human immunodeficiency virus infection in women undergoing treatment for cervical neoplasia: prevalence and the feasibility of routine screening.

This study was undertaken to evaluate the prevalence of human immunodeficiency virus (HIV) infection and the feasibility of routine HIV screening in women undergoing various treatment of cervical neoplasia at Chiang Mai University Hospital between October 2004 and October 2006. Four hundred and ninety five women were recruited for HIV screening with the opt-out approach performed. In this study, thirty-seven (7.47%) women had a previous diagnosis of HIV infection with a mean duration 4.16 years (range: 1-15 years). The remaining 458 women consented to have an HIV test. Six women (1.31%) were newly identified as HIV seropositive, giving an overall prevalence of 8.69%. In conclusion, the prevalence of HIV infection in this study was considerably high and routine HIV screening is feasible because of the high acceptance rate.