垂体腺瘤的分子病因学研究进展

垂体腺瘤是发生于垂体前叶的良性肿瘤，约占中枢神经系统肿瘤的10％-20％，而无功能微腺瘤占到成人尸检的23％左右。生理上根据免疫组化将垂体腺瘤按功能分为有激素分泌活性腺瘤（functioning pituitary adenoma，FPA）和非激素分泌活性腺瘤（non—functioning pituitary adenoma，NFPA）两大类。[第一段]     

系统性红斑狼疮女性患者血清CA125,CA199化学发光法测定的临床应用

目的 :探讨系统性红斑狼疮 (SLE)女性患者血清肿瘤标志物CA12 5 ,CA199含量变化及临床意义。方法 :用化学发光法测定 30例正常女性和 38例SLE女性患者血清中CA12 5 ,CA199含量。结果 :正常组CA12 5含量为 11.14± 6 .4 8U/ml,CA199含量为 3.75± 2 .89U/ml;SLE组CA12 5 ,CA199分别为 2 2 .5 6± 2 0 .4 6U/ml,9.5 7± 9.34U/ml。SLE患者CA12 5 ,CA199阳性率分别为 2 1.1% ,7.89%。结论 :SLE患者血清CAl2 5 ,CA199含量较正常组增高 (P <0 .0 5 )。CA12 5 ,CA199在SLE女性患者中可出现阳性 ,对临床诊断SLE有一定价值。     

Vaginal topography does not correlate well with visceral position in women with pelvic organ prolapse

The objective was to determine whether vaginal topography accurately predicts the location of the pelvic viscera on fluoroscopy in women with pelvic organ prolapse. Eighty-nine women undergoing preoperative evaluation for reconstructive pelvic surgery at a tertiary care referral practice formed the study population. Each woman completed a comprehensive urogynecologic history and physical examination, which included a quantified (POP-Q) assessment of her vaginal topography, as described by Bump et al. In addition each woman underwent pelvic floor fluoroscopy (PFF). Visceral sites were selected which corresponded clinically to the vaginal sites measured by the POP-Q. The most dependent portion of the bladder, small intestine, rectum and urethrovesical junction was measured. Twenty-five (28%) women had stage II prolapse, 34 (38%) had stage III prolapse, and 28 (32%) had stage IV prolapse. The remaining 2 women were symptomatic, with stage I prolapse. For the entire study population there was no correlation between the fluoroscopic position of the small bowel and/or rectum and any apical or posterior wall POP-Q site (C, Ap or Bp). There was no correlation with the fluoroscopic position of the UVJ at rest or with straining and the corresponding POP-Q site (Aa). The fluoroscopic position of the most dependent portion of the bladder correlated only modestly with the upper (Ba,ρ=0.51) and lower Aa,ρ=0.68) anterior vaginal wall POP-Q sites. In women without prior surgery (n=33) there was only modest correlation between the fluoroscopic position of the bladder and the corresponding POP-Q site (Aa,ρ=0.71). In this unoperated subpopulation there was no correlation with PFF and any other POP-Q site. In women who had undergone prior hysterectomy (n=25) or hysterectomy with anterior and/or posterior colporrhaphy (n=17), there was only a modest correlation of the most dependent portion of the bladder and the upper anterior vaginal wall site (Bb,ρ=0.67 andρ=0.55, respectively). It was concluded that vaginal topography does not reliably predict the position of the associated viscera on PFF in women with primary or recurrent pelvic organ prolapse. EDITORIAL COMMENT: The authors seek to evaluate whether physical examination of vaginal prolapse using the POP-Q test correlates with fluoroscopic findings of visceral position. Surprisingly, little correlation is found, even in previously unoperated patients. One reason for this lack of correlation between the two modalities of evaluation may lie in the use of two different fixed points of reference: the POP-Q examination uses the hymen as the fixed point of reference, whereas the investigators chose to use the posterior edge of the femur as a fixed bony point of reference when evaluating pelvic floor fluoroscopy in the same patient. The lack of correlation between visual inspection of vaginal wall prolapse and what lies deep to that prolapse should not be used to invalidate the use of the POP-Q as a means to evaluate pelvic prolapse. Rather, the findings support the premise behind the ICS/AUGS/SGS committee on pelvic organ prolapse, specifically that clinical pelvic examination of the vaginal walls looks at surfaces only, and as such cannot determine what, if any, organ lies deep to that surface.     

肾细胞癌伴静脉癌栓15例临床分析

１９８５～１９９４年治疗肾细胞癌伴静脉癌栓１５例。按癌栓水平分为肾型１０例，肝下型４例，肝上型１例。Ｂ超和ＣＴ检查总确诊率７３％。手术１４例均完整取出癌栓，术后１３例接受５－ＦＵ加ＭＭＣ方案化疗。随访３个月～５年，１例肝下型和２例肾型无瘤存活分别３６、４３、５２个月，余均在术后２年内死亡。认为Ｂ超与ＣＴ互补应用可基本确诊静脉癌栓，除肝上型和已有血管壁浸润者外大部分癌栓可采用松解游离同时渐渐拉出的方式取出，癌栓水平除肝上型外对预后影响不大。     

Role of the pelvic floor in bladder neck opening and closure I: Muscle forces

The aim of the study was to identify the striated muscle forces hypothesized to assist bladder neck opening and closure in females. Cadaveric dissection was used to identify the levator plate (LP), the anterior portion of pubococcygeus muscle (PCM), the longitudinal muscle of the anus (LMA), and their relation to the bladder, vagina and rectum. X-ray video recordings were made during coughing, straining, squeezing and micturition in a group of 20 incontinent patients and 4 controls, along with surface EMG, urethral pressure and digital palpation studies. During effort, urethral closure appeared to be activated by a forward muscle force corresponding to PCM, and bladder neck closure by backward muscle forces corresponding to LP and LMA. During micturition the PCM force appeared to relax, allowing LP and LMA to pull open the outflow tract. The data appear to support the hypothesis of specific directional muscle forces stretching the vagina to assist bladder neck opening and closure.     

Staging-laparoscopy

Summary. The so-called extended diagnostic laparoscopy (EDL) facilitates the comprehensive exploration of the abdominal cavity, thus improving the precision of the pretherapeutic tumor staging in gastrointestinal malignancies. EDL comprises visual inspection with a specific preparation of all relevant sites, laparoscopic sonography and retrieval of samples for biopsy and cytology. Additional relevant therapeutic information was obtained through EDL in 40.5 % of gastric cancer patients. EDL could be of similar importance for diagnosing esophageal, hepatobiliary and pancreatic malignancies.      

瘤体骨切除灭活再植治疗四肢长骨巨细胞瘤

体内刮除及灭活植骨治疗骨巨细胞瘤（ＧＣＴ）的复发率高。我科从１９８６年６月～１９９６年２月治疗四肢长骨ＧＣＴ２４例。随访１１个月～８年４个月。其中７例采用局部切刮体内灭活植骨和（或）骨水泥充填治疗。结果１例感染，６例复发，１例恶变后死于肺转移。作者自１９９１年１月采用瘤体骨切除，离体灭活再植，与骨残端体内灭活相结合，骨缺损采用自家腓、髂骨移植，Ｌ－梯形加压钢板（Ｌ－ＴＣＰ）或梯形加压钢板（ＴＣＰ）固定治疗１７例，其中１２例保留关节，５例做膝关节融合。本组无菌创口感染１例，１例复发。在保留关节的１２例中９例关节功能恢复优良，１例尚可，２例差。充分说明瘤段骨切除体外灭活再植术疗效确实，复发率低。保留关节术式适于关节破坏较轻（＜＝１／２）者，结合关节残端体内灭活和有效的骨结构重建，有利于恢复关节功能。如关节面累及＞１／２，宜做骨关节端切除，灭活再植，下肢宜做关节融合或人工关节置换术。     

A New Serum Tumor Marker, CAM 123-6, Highly Specific to Pulmonary Adenocarcinoma

KL-6, a circulating mucin-like glycoprotein, is a pulmonary adenocarcinoma-associated antigen and is also regarded as an indicator of disease activity of interstitial pneumonitis. KL-6 has extensive heterogeneous antigenic determinants and consists of multiple heterogeneous antigen molecules. We have searched for circulating KL-6-associated glycoproteins with superior diagnostic value to KL-6 as a tumor marker for pulmonary adenocarcinoma. A new murine monoclonal antibody EH-123 reacting with an asialosugar chain on KL-6 was established. A new KL-6-associated molecule detected by a bimonoclonal bideterminant sandwich assay using the EH-123 antibody as a catcher and horseradish peroxidase-labeled KL-6 as a tracer was designated as CAM 123-6. In 59% (22 of 37) of patients with pulmonary adenocarcinoma, serum levels of CAM 123-6 were abnormally elevated and the positive rate increased with the progression of clinical stage. Elevated levels were not detected in normal individuals or in patients with benign lung diseases, other histologic types of lung cancer, gastric cancer, colon cancer or breast cancer. CAM 123-6 was more specific to pulmonary adenocarcinoma than carcinoembryonic antigen (CEA), but the sensitivity of CAM 123-6 for pulmonary adenocarcinoma was similar to that of CEA. CAM 123-6 is a promising candidate as a serum tumor marker for pulmonary adenocarcinoma.     

Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation

The purpose of the study was to compare the effect of voluntary pelvic floor muscle (PFM) contraction and vaginal electrical stimulation on urethral pressure. Twelve women with genuine stress incontinence, mean age 49.4 years (range 33–66) participated in the study. The urethral and bladder pressures were recorded simultaneously through a double-lumen 8 Ch catheter. The patients first performed three voluntary PFM contractions. Then two electrical stimulators, Conmax and Medicon MS 105, 50 Hz, were used in random order. A visual analog scale was used to measure pain and discomfort. Pain was reported to mean 6.8, SEM 0.64 (range 0.7–9.9) and mean 6.1, SEM 0.81 (range 0–9.1) with Conmax and Medicon MS 105, respectively. The mean paired difference in favor of voluntary contraction with Conmax was ?8.0, SD 6.7,P=0.0067, and with Medicon MS 105 it was ?12.2, SD 5.9,P=0.0022. The results demonstrated that voluntary PFM contraction increased urethral pressure significantly more than did vaginal electrical stimulation.     

Relationship between renal capsular artery feeding and size of VX-2 carcinoma implant in the rabbit kidney

When regional intraarterial infusion is applied in the treatment of malignant tumors it is essential to reach the tumor via all its major feeder vessels. In this study VX-2 carcinoma was implanted into the lower pole of the left kidney in 24 rabbits to investigate whether the renal capsular artery takes part in tumor feeding. The rabbits were divided into four groups that were followed for 8, 10, 12 or 14 days after tumor implantation. At that time the renal artery was ligated close to the kidney and subsequently silicone rubber or barium sulfate/gelatin suspension was injected into the capsular artery. The tissue was cleared, and the tumor carefully removed and examined microscopically for traces of silicone rubber. When barium sulfate had been injected, the kidney was examined radiographically in order to detect possible presence of contrast medium in the tumor. This study revealed no vascular supply to the implanted VX-2 carcinoma from the capsular artery when the tumor was confined intracapsularly, i.e., up to 12 days after tumor implantation in untreated rabbits.This investigation was performed at the Oncological Research Laboratory, Department of Diagnostic Radiology, University of Bergen, Bergen, Norway