术中射频消融后病灶刮除治疗脊柱转移瘤

目的:探讨术中射频消融(RFA)后再行病灶刮除术治疗脊柱转移瘤的可行性及疗效.方法:2004年～2006年,对11例脊柱转移瘤患者术中实施RFA后再行病灶刮除术,将FRA前后病灶标本进行光镜和电镜病理检查,随访患者疼痛缓解情况及肿瘤复发情况.结果:术中未出现脊髓和神经根损伤,RFA后瘤组织固缩,刮除顺利,出血量350～3800ml,平均1024.5ml.全部病例得到6个月以上随访,平均9.8个月,全部患者生存期超过6个月,VAS评分术前平均5.8分,术后6个月时平均1.9分.1例出现局部肿瘤复发.RFA前的标本光、电镜检查均未见肿瘤组织坏死.RFA后光镜检查3例无明显坏死,9例肿瘤细胞完全坏死:电镜检查10例肿瘤细胞完全坏死,1例肿瘤细胞部分坏死,1例无明显坏死.结论:术中RFA后再行病灶刮除治疗脊柱转移瘤安全可行,有利于肿瘤的刮除,减少局部复发的风险.     

Bisphosphonate-related Osteonecrosis of the Jaws: An Update on Clinical, Pathological and Management Aspects

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is mainly observed in patients with multiple myeloma and bone metastasis from solid tumors receiving iv bisphosphonate therapy. The reported incidence of BRONJ is significantly higher with the iv preparations zoledronic acid and pamidronate while the risk appears to be minimal for patients receiving oral bisphosphonates. Currently available published incidence data for BRONJ are based on retrospective studies and estimates of cumulative incidence range from 0.8 to 12%. The mandible is more commonly affected than the maxilla (2:1 ratio), and 60–70% of cases are preceded by a dental surgical procedure. The signs and symptoms that may occur before the appearance of clinical evident osteonecrosis include changes in the health of periodontal tissues, non-healing mucosal ulcers, loose teeth and unexplained soft-tissue infection. Although the definitive role of bisphosphonates remains to be elucidated, the inhibition of physiologic bone remodeling and angiogenesis by these potent drugs impairs the regenerative capacity of the bone causing the development of BRONJ. Tooth extraction as a precipitating event is a common observation. The significant benefits that bisphosphonates offer to patients clearly surpass the risk of potential side effects; however, any patient for whom prolonged bisphosphonate therapy is indicated, should be provided with preventive dental care in order to minimize the risk of developing this severe condition. This article provides an update review of current knowledge about clinical, pathological and management aspects of BRONJ.     

肺腺癌经支气管肺转移的CT表现

目的认识肺腺癌经支气管播散肺转移的CT表现和规律。方法回顾性分析15例经病理证实为腺癌或细支气管肺泡癌经支气管肺转移患者的CT表现，重点关注病变的发展特点。结果15例肺癌患者在CT上原发病灶均为实变型肺癌，在同侧或对侧肺内出现多发性、与支气管分布有明确相关的病灶，胸膜不受累。在初诊的CT上表现为小叶中心性结节5例、树芽征7例、腺泡结节2例、磨玻璃影10例和实变13例，其中5例仅有小叶中心结节（单一型），10例为多种形态病变共存（复合型），曾全部被误诊为结核或炎症，经抗结核或抗炎治疗无效。在平均4个月的CT随访中，单一型转移者进展缓慢，结节融合形成边界相对清晰的实变影；初诊为复合型的病变恶化较快。结论肺腺癌经支气管转移的CT表现有一定规律，但诊断仍须结合临床及实验室检查，以区别于结核和炎性反应。     

c-Met及HGF在胃癌及其肝转移灶中的表达

目的:探讨胃癌肝细胞生长因子受体(c-Met)及肝细胞生长因子(HGF)表达与胃癌肝转移间的相关性。方法:晚期胃癌标本59例,其中11例同时有取自左肝外叶的肝转移标本,应用免疫组化方法对上述组织石蜡标本进行检测。结果:59例胃癌中,c-Met阳性率55.8%(33/59),HGF阳性率28.8%(17/59);在29例发生了同时或异时性肝转移的胃癌标本中,c-Met表达率为75.9%(22/29),HGF阳性率为37.9%(11/29),其中c-Met表达率在有和无肝转移组间有显著差异(P<0.05);在11例胃癌肝转移灶中,9例c-Met阳性表达率为81.8%,3例HGF阳性表达率为27.3%。结论:胃癌组织c-Met表达可能与胃癌肝转移行为相关。     

结直肠癌肝转移的外科手术治疗

目的评价手术治疗对结直肠癌肝转移病人生存率的影响。方法回顾分析2000年1月1日至2004年12月31日复旦大学附属中山医院收治的363例结直肠癌肝转移病人，其中91例为手术病例，评价手术治疗对生存率的影响。结果160例同时性肝转移病人中手术切除肝转移灶22例（13．8％），203例延时性肝转移病人中手术切除肝转移灶69例（34．0％），两者相比差异具有统计学意义（P〈0．000）。同时性肝转移组手术死亡率（4．5％，1／22）高于延时性肝转移组（2．8％，2／69），两者相比差异有统计学意义（P〈0．05）。以2005年6月31日为随访终点，91例病人随访率100％，手术病人中同时性肝转移组1、3、5年生存率和中位生存时间与延时性肝转移组相似（P〉0．05），但术后复发率较高（36．4％vs21．7％，P=0．03）。363例病人中有36例具有手术指征而未手术病例，其1、3、5年生存率分别为47．9％、5．34％和0，明显低于91例手术病例（80．5％、33．0％和22．7％），（P=0．0034）。应用COX比例风险模型，对所有91例手术病人影响生存的因素进行多因素风险分析，得出手术切缘达1cm（β=-0．8351，P=0．0363）和复发后再次手术（β=-0．9428，P=0．0411）是生存的保护性因素，而术后复发（β=0．6471，P=0．0226）是生存的危险因素。结论手术治疗是结直肠癌肝转移的首选治疗措施，可以明显提高病人的术后生存。     

双功能域重组FN多肽抑制癌细胞浸润能力的研究

在制备了两个Cell Ⅰ-Hep Ⅱ 双结构域重组FN多肽(CH50和CH56)的基础上,研究其抑制肿瘤细胞浸润能力的作用。两个多肽的结构差异是CH50中删除了Cell I和HepⅡ之间的Ⅲ-11和ED-A结构顺序。CH50(ED_(50)为30.2 nmol/L)结合细胞的能力略高于CH56(ED_(50)为45.4 nmol/L)。两种多肽均可显著抑制黑色素瘤B16/F1细胞结合层粘素的能力,抑制作用相同。在体内肿瘤浸润抑制试验中,两种多肽均可显著抑制癌细胞浸润能力,使肺转移结节数降低80％左右。结果提示:Ⅲ-11和ED-A结构顺序对Cell Ⅰ-Hep Ⅱ 双结构域多肽结合细胞的能力有一定的影响,但删除Ⅲ-11和ED-A不是重组多肽抑制肿瘤转移的决定因素,Cell I和Hep Ⅱ 这两个结构域单独连接在一起是其抑制肿瘤细胞转移的结构基础。     

高转移小鼠肺癌株细胞导入人基因组DNA后的转移表型抑制

目的 探讨从正常人细胞基因组ＤＮＡ中寻找、分离并鉴定肿瘤转移抑制基因或相应ＤＮＡ序列的新途径。方法 采用体内转移灶体外再培养再硬琼脂集落克隆化筛选，获体内９０％以上高转移率小鼠肺腺癌ＬＭ２细胞株；使用磷酸钙共沉淀ＤＮＡ转染技术，将正常细胞人基因组ＤＮＡ随机片段，导入高转移小鼠肺癌细胞株ＬＭ２后，使用有限稀释法克隆化其中形态扁平的回复突变株。为证实细胞确实含有外源人ＤＮＡ序列，设计人特异性Ａｌｕ引物     

Brain Metastasis from Prostate Cancer: A Case Report

Brain metastases from prostate cancer are rare in postmortem examinations, and even rarer in clinical series. We report an unusual case of brain metastasis from prostate cancer confirmed by antemortem diagnosis in a 72-year-old man. The metastatic brain tumor was surgically resected and the patient was kept stable for more than 19 months after diagnosis of the brain metastasis.     

乌苯美司的药物动力学及对实验性肿瘤转移的治疗作用

目的：探讨乌苯美司对小鼠药物动力学及与实验性肿瘤转移治疗活性间的关系。方法：用放射免疫法测定小鼠在不同给药途径下的乌苯美司血清药物动力学及观察乌苯美司对黑色素瘤肺转移模型的治疗活性。结果：乌苯美司ｉｖ的Ｔ１２较短，初始血药浓度较高。ｉｖ和ｉｍ给药后的曲线下面积较大；ｐｏ及ｉｐ则较小。不同给药途径对实验性肿瘤转移均有治疗作用。结论：乌苯美司的血清Ｔ１２较短，其治疗活性取决于冲击和高剂量的给药方式。     

Early gastric cancer manifested as brain metastasis: Report of a case

A case of early gastric cancer, limited to submucosal layer, which was manifested as cerebral metastasis is presented herein. A 47-year-old man was admitted to Nagaoka Chuo General Hospital with convulsions and a disturbance in consciousness, where a computed tomography (CT) scan revealed a cerebral tumor in the left temporal lobe. The resected tumor was identified as a metastatic adenocarcinoma. Further investigation revealed gastric cancer involving the posterior wall of the cardia. At laparotomy, multiple and small metastases of the liver and a jejunal metastasis were found, and a palliative total gastrectomy was performed. The surgical specimen revealed a protruding, poorly differentiated medullary adenocarcinoma, with invasion of the submucosal layer. The patient died 4 months after undergoing the laparotomy. This case report is presented to make clinicians aware of the possibility that early gastric cancers may present as brain metastasis.