喉癌前病变中医证候及四诊特征初步研究

目的通过临床调查探讨喉癌前病变的中医证候及四诊特点,为喉癌前病变的中医药防治及研究提供参考和思路。方法采用流行病学横断面调查方法,对88例喉癌前病变、100例声带息肉及60例喉癌患者的中医证候及四诊资料进行采集分析。结果在声带息肉→喉癌前病变→喉癌的病情进展过程中,中医证候演变特点：以痰瘀为主线,证候由单一向证候兼杂发展,最终出现痰瘀热毒、气阴两虚等多种证候因素兼杂的情况。舌象变化特点：随着病情的发展变化,舌象可由正常的淡红舌为主,向暗红舌、红绛舌、紫舌等发展;舌苔由淡白、白腻向薄黄、黄腻到黄老厚腻变化发展;舌边瘀斑瘀点及舌下静脉曲张的情况更普遍。结论痰瘀是喉癌前病变的基本病因病机,贯穿于喉癌前病变发生发展的始终。     

Molecular Analysis of PIK3CA, BRAF, and RAS Oncogenes in Periampullary and Ampullary Adenomas and Carcinomas

Background  Mutations of KRAS are known to occur in periampullary and ampullary adenomas and carcinomas. However, nothing is known about NRAS, HRAS, BRAF, and PIK3CA mutations in these tumors. While oncogenic BRAF contributes to the tumorigenesis of both pancreatic ductal adenocarcinoma and intraductal papillary mucinous neoplasms/carcinomas (IPMN/IPMC), PIK3CA mutations were only detected in IPMN/IPMC. This study aimed to elucidate possible roles of BRAF and PIK3CA in the development of ampullary and periampullary adenomas and carcinomas. Methods  Mutations of BRAF, NRAS, HRAS, KRAS, and PIK3CA were evaluated in seven adenomas, seven adenomas with carcinoma in situ, and 21 adenocarcinomas of the periampullary duodenal region and the ampulla of Vater. Exons 1 of KRAS; 2 and 3 of NRAS and HRAS; 5, 11, and 15 of BRAF; and 9 and 20 of PIK3CA were examined by direct genomic sequencing. Results  In total, we identified ten (28.6%) KRAS mutations in exon 1 (nine in codon 12 and one in codon 13), two missense mutations of BRAF (6%), one within exon 11 (G469A), and one V600E hot spot mutation in exon 15 of BRAF. BRAF mutations were present in two of five periampullary tumors. All mutations appear to be somatic since the same alterations were not detected in the corresponding normal tissues. Conclusion  Our data provide evidence that oncogenic properties of KRAS and BRAF but not NRAS, HRAS, and PIK3CA contribute to the tumorigenesis of periampullary and ampullary tumors; BRAF mutations occur more frequently in periampullary than ampullary neoplasms.     

CT导引下经皮肺穿刺切割活检术后并发症的相关因素分析

目的:统计CT导引下经皮肺穿刺切割活检(ACNB)术后并发症并分析影响因素。方法:回顾性总结352例胸膜外定位法(EPL)ACNB结果,对主要并发症出血及气胸相关因素行多因素非条件Logistic回归分析。结果:活检准确率为94.9%,每例操作时间为(16.0±2.0)min。出血率22.7%,咯血率5.1%,Logistic分析提示肺不张(OR值0.321)为保护因素。气胸率17.0%,迟发性气胸1.4%,封闭引流率0.6%,Logistic分析提示合并慢性阻塞性肺疾病(COPD)(OR值11.224)及病灶直径(OR值2.556)是气胸发生的危险因素。出血并气胸率6.0%。胸膜反应及术后持续性疼痛各1例。严重并发症率1.4%。结论:CT导引下EPL法ACNB诊断准确率高,出血及气胸是主要并发症,合并肺不张出血率低,合并COPD及病灶直径小气胸率高,要警惕迟发性并发症及严重并发症的发生。     

Impact of Regional Lymph Node Evaluation in Staging Patients With Periampullary Tumors

Background Two distinct lymph nodes reproducibly assessed by computed tomography for the evaluation of periampullary tumors are the common bile duct (CBD) node and the gastroduodenal artery (GDA) node. We examined whether radiographical enlargement of either lymph node predicts tumor resectability, nodal metastasis, or patient survival. Methods Ninety-four consecutive patients underwent attempted curative resection of periampullary tumors between September 2001 and June 2003. A single radiologist recorded in a retrospective, blinded fashion the short- and long-axis measurements of the CBD and GDA nodes. Results Sixty-one percent (n = 57) of tumors were resectable by pancreaticoduodenectomy. Overall, actual 6-, 12-, and 18-month survival was 87%, 68%, and 63%, respectively. Enlarged radiographical nodal size by either axis was not associated with the presence of metastasis to these lymph nodes or with reduced overall patient survival. Only a CBD node short-axis size >10 mm predicted unresectability (odds ratio, 3.2; P = .036). Liver metastasis and/or carcinomatosis were present in 43% of unresectable patients, and this was associated with decreased survival at both 1 year (25% vs. 77%; P < .001) and 18 months (19% vs. 72%; P <.001). A pathologic diagnosis of metastasis to the GDA node, but not the CBD node, was associated with a similarly decreased survival (1 year: 33% vs. 78%, P = .028; 18 months: 22% vs. 70%, P = .023). Conclusions For presumed periampullary malignancy, a CBD node short-axis size >10 mm predicts tumor unresectability. Metastatic disease to the GDA node, particularly for pancreatic adenocarcinoma, portends a poor prognosis equivalent to that of hepatic or peritoneal spread. Given these findings, radiographical CBD lymph node measurements may guide selection for performing laparoscopic staging with or without ultrasonography in conjunction with GDA nodal biopsy in patients with periampullary malignancy. Presented in part at the annual meetings of the American Hepato-Pancreatico-Biliary Association on April 15, 2005 and The Pancreas Club on May 15, 2005.     

与眼眶疾病相关的复视问题及治疗对策

复视是眼眶疾病中较为常见的临床表现,严重影响患者的生活质量.眼眶骨折、甲状腺相关眼病和眼外肌病变是常见的眼眶疾病,复视为共同特征.本文介绍了眼眶骨折造成复视的机制、检查方法及手术适应证和手术时机.甲状腺相关眼病可累及眼外肌,炎症活动期和静止期均可发生复视,但治疗方案有所不同.眼外肌病变包括特发性炎症、寄生虫囊肿及多种良、恶性肿瘤,经手术明确病理诊断后给予针对性治疗,可有效改善复视.     

胃癌及癌前病变胃粘膜的粘液组织化学研究

本文应用粘液组织化学方法对168例肠化生、96例异型增生和89例胃癌胃粘膜活检标本进行观察,发现87.6％的胃癌和40.6％的异型增生组织有异常粘液分泌;不全结肠型肠化生和硫酸粘液阳性肠化生在癌旁和异型增生的检出率显著地高于萎缩性胃炎组(P<0.05);伴不全结肠型肠化生和伴其它型肠化生的胃癌患者平均年龄分别为59.5岁和54.4岁、男女比为6∶1和2.25∶1.结果提示有异常粘液分泌的异型增生、伴不全结肠型化生的异型增生、不全结肠型化生的高龄男性、伴不全结肠型化生的胃良性疾病和硫酸粘液阳性肠化生宜被看作是胃癌的癌前病变,其中前三组的癌变趋向性更大.     

6-OHDA-Lesions of the Nucleus Accumbens Disrupt the Acquisition but not the Maintenance of Ethanol Consumption in the Alcohol-Preferring P Line of Rats

The aim of the present study was to determine whether reduction of dopamine (DA) innervation to the nucleus accumbens (ACB) alters the maintenance and/or acquisition of ethanol drinking in female alcohol-preferring P rats. Compared with sham-lesioned animals, bilateral microinjections of 6-OHDA (12 μg/2.4 μl/site) into the ACB did not alter the consumption of 10% ethanol in rats that had prior experience of ethanol drinking, with both sham- and 6-OHDA-lesioned groups recovering to presurgical consumption levels at similar rates. On the other hand, the identical lesion procedure disrupted the acquisition of ethanol intake in rats with no ethanol-drinking experience prior to the lesions. A sham-lesioned group attained an ethanol intake of approximately 7 g/kg/day in 1 week, which was maintained over the following 2-week period, while the ethanol intake of the 6-OHDA-lesioned group was approximately 60% lower after 1 week and 30% lower at the end of 3 weeks. DA content of the ACB was 60% lower in both groups of the 6-OHDA-treated rats compared with the controls. The results suggest that different neural mechanisms may underlie the acquisition and maintenance of ethanol drinking behavior; the ACB DA system appears to play an important role in the acquisition of ethanol drinking.     

Experimental mycotic encephalitis

Summary Oidiodendron kalrai infection in mice is presented as a suitable model for the study of the pathogenesis of mycotic encephalitis. Intravenous inoculation of cortisone-treated and non-treated mice with the yeast-phase ofO. kalrai resulted in a neurologic syndrome characterized by head tilt, circling, hyperexcitability and ataxia. Signs of neurologic disease appeared earlier and were more severe in cortisone-treated animals.Grossly detectable areas of hemorrhage, necrosis and edema were apparent in over 80 percent of the cortisone-treated mice killed 4–6 days after infection. Lesions were demonstrated microscopically in the CNS of all mice infected withO. kalrai from the second to the 35th day following inoculation. Mice not treated with cortisone developed an immediate histiocytic response leading to the arrest of fungal proliferation by the 3rd day and to regression and scarring by the 7th day following infection. In cortisone-treated mice the cellular response was delayed and primarily neutrophilic and fungal growth continued through the 6th day after infection. The distribution of lesions was similar in both groups, although the lesions were more extensive in mice treated with cortisone.The mycelial-phase was the invasive form ofO. kalrai, while the arthrospore represented the form most resistant to the hosts' inflammatory response. The possible mechanisms of cellular penetration by the fungus and the role of cortisone in the altered course of the disease are discussed.This study was supported in part by Grants GM 1052 and FR-05264 from the National Institute of Health.     

Exploration of the pineal region: observations and results

Experience with direct exploration of the pineal region in 22 consecutive patients is reported. Of these cases, mass lesions with obstructive hydrocephalus were found in 19; the remaining 3 had arteriovenous malformations of the pineal region. Of the 19 mass lesions, 5 (26%) were benign and curable. Although a preliminary shunt was routinely provided in all patients with obstructive hydrocephalus before exploration of the pineal region, the condition of five (26%) worsened after the shunt operation, requiring emergency decompression of the pineal tumor. A transtentorial approach through a right occipital craniotomy was uniformly employed in all cases. Overall mortality was less than 5%. These observations and results support the policy of direct exploration of all lesions in the pineal region.     

Informational and arousal properties of olfaction

The effects of lesions confined to the anterior tip of the olfactory bulbs on locomotor activity are dependent upon the extent of the animals' exposure to the testing environment. Rats habituated to the test situation are hypoactive, while those not habituated to the test situation are hyperactive. The apparent effects of olfactory deaffentation are to lower arousal level and to interfere with habituation to the testing environment.