早、中期胃癌的临床病理学研究(附75例报告)

目的　了解早、中期胃癌的临床、胃镜和病理学特征。方法　回顾性分析我院 11年中经外科手术和病理诊断的 75例早、中期胃癌患者的临床、胃镜、外科手术和病理等方面资料。结果　早、中期胃癌临床表现无特征性 ,男女之比为 2 .41∶1,以 61～ 70岁最多 ,胃窦是其好发部位 ,病理组织学以管状腺癌为多 ,胃镜误诊率是 12 .86%,淋巴转移率是 2 5 .3 3 %。结论　早、中期胃癌有明显的好发年龄和好发部位 ,以管状腺癌为多 ,胃镜误诊的主要原因是不能鉴别病变的良、恶性和准确判断病变量 ,影响淋巴转移的因素是浸润深度、广度、肿瘤大小和年龄 ,而与性别、组织学的分化程度无明显关系。     

In vivo fluorescence spectroscopy and imaging of human skin tumours

The feasibility of using in vivo autofluorescence for the diagnosis of skin cancer was evaluated. In vivo fluorescence measurements were performed on healthy human volunteers, and patients with different types of benign and malignant skin tumours. Fluorescence spectra as well as fluorescence images were acquired. The excitation-emission matrix of normal skin (n=3) showed a broad peak at the shortest excitation wavelength (365 nm) and at 440 nm fluorescence wavelength, smoothly decreasing towards longer excitation and fluorescence wavelengths. Non-melanoma skin tumours (n=31) and control skin excited with 375 nm showed a broad fluorescence band from 400 to 700 nm, peaking around 436 nm. No significant differences in measurements between tumours and the corresponding control sites were found. A large spatial variation in the fluorescence intensity was observed both in the tumours and in the control sites. Standard deviations found ranged from 0.15 to 1.5 times the mean fluorescence. Fluorescence images, excited with 375 nm and taken with an image intensified CCD camera, on eight malignant melanomas and eight benign pigmented lesions did not indicate any fluorescence intensity distribution specific to the malignancy of the lesion. Neither the shape of the fluorescence spectra, nor the spatial distribution of the fluorescence intensity showed any signature specific to the histopathological nature of the lesions investigated. Optical diagnostics of skin tumours using the autofluorescence does not seem to be feasible at the present time.     

Erfahrungen zur PFFB von isolierten radiusköpfchenfrakturen

Zusammenfassung Den Vorteilen einer osteosynthetischen Versorgung einer Fraktur mit sofortiger Aufnahme seiner Funktion, stehen die aus der Literatur bekannten Komplikationen gegenüber. Diese und unsere eigenen unbefriedigenden Ergebnisse nach der operativen Versorgung von Radiusköpfchenfrakturen ließen uns zu einer prospektiven randomisierten Studie einer primär funktionellen Behandlung unter Verzicht auf eine äußere oder innere Stabilisierung greifen. Seit Dezember 1991 haben wir im UKH-Graz bis einschließlich Dezember 1992 insgesamt 70 Patienten nach einem strikten Behandlungskonzept, unter Zuhilfenahme der Computertomographie zur Verlaufsbeobachtung versorgt. Die in 91% der Fälle als sehr gut and gut einzustufenden Frühergebnisse sowie das fehlende Auftreten einer, wie bei operativer Versorgung möglichen Komplikation, ebenso die zusätzlich deutlich frühere Arbeitsfähigkeit bzw. deutlich kürzere, wenn auch aufwendigere Behandlungszeit, lassen uns diese Verfahren nicht nur in unserem Hans weiterführen, sondern können wir auch weiter empfehlen.

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Experience with internal fixation of fractures of the head of the radius

The advantages of internal fixation of fractures, with the possibility of immediate resumption of the function of the fractured bone, are in contrast to the well-known complications described in the literature. These complications and our own unsatisfactory results after surgical treatment of fractures of the head of the radius induced us to carry out a randomized prospective study of primary functional treatment of such fractures without external or internal stabilization. From December 1991 through December 1992, a total of 70 patients were treated according to a strict treatment protocol at the Graz Hospital for Accident Surgery, and CT was used for observation of the healing process. The positive early results, which in 91% of all cases were classified as very good or good, the lack of complications that sometimes follow surgical treatment, the markedly earlier recovery of the patient's working capacity, and the clearly shorter — albeit somewhat more expensive — treatment period required have led us to continue using this method at our hospital and also to recommend its use elsewhere.

     

Bromodeoxyuridine Labeling Index as an Indicator of Early Tumor Response to Preoperative Radiotherapy in Patients with Rectal Cancer

Purpose Assessment of tumor proliferation rate using Bromodeoxyuridine labeling index (BrdUrdLI) as a possible predictor of rectal cancer response to preoperative radiotherapy (RT). Methods and material Ninety-two patients were qualified either to short RT (5 Gy/fraction/5 days) and surgery about 1 week after RT (schedule I), or to short RT and 4–5 weeks interval before surgery (schedule II). Tumor samples were taken twice from each patient: before RT and at the time of surgery. The samples were incubated with BrdUrd for 1 h at 37°C, and the BrdUrdLI was calculated as a percentage of BrdUrd-labeled cells. Results Thirty-eight patients were treated according to schedule I and 54 patients according to schedule II. Mean BrdUrdLI before RT was 8.5% and its value did not differ between the patients in the two compared groups. After RT tumors showed statistically significant growth inhibition (reduction of BrdUrdLI). As the pretreatment BrdUrd LI was not predictive for early clinical and pathologic tumor response, prognostic role of the ratio of BrdUrdLI after to BrdUrdLI before RT was considered. The ratios were calculated separately for fast (BrdUrd LI > 8.5%) and slowly (BrdUrd LI ≤ 8.5%) proliferating tumors and correlated with overall treatment time (OTT, i.e., time from the first day of RT to surgery). One month after RT, accelerated proliferation was observed only in slowly proliferating tumors. Conclusions Pretreatment BrdUrdLI was not predictive for early clinical and pathologic tumor response. The ratio after/before RT BrdUrdLI was correlated to inhibition of proliferation in responsive tumors. The paper was presented at ECCO 13, October 30 to November 03, 2005 in Paris, France     

幼年型强直性脊柱炎5例诊治分析

幼年型强直性脊柱炎（Juvenile ankylosing spondylitis）不同于成人型强直性脊柱炎的脊柱椎间盘、纤维环韧带骨化融合和骶髂关节破坏,而主要表现为髋膝等外周大关节不对称性破坏所致的反复发作性肿痛,而腰背部及骶髂关节痛不明显。     

平扫CT与HRCT诊断强直性脊柱炎骶髂关节病变的对照研究

目的比较平扫CT和HRCT在强直性脊柱炎(AS)骶髂关节病变分级中的作用。方法对82例AS患者骶髂关节的平扫CT及HRCT表现进行分析。平扫CT检查使用GEHispeed型螺旋机,层厚5mm,间隔5mm。HRCT采用高分辨骨算法重建,层厚1.25mm,间隔5mm。依据纽约放射标准对病变分级,作平行对照研究,并进行统计学分析。结果对照研究表明,9个关节平扫CT可疑的病变,HRCT可以肯定诊断;22个关节平扫CT表现为早期病变(0~Ⅱ级)的患者HRCT对其分级更为准确;Ⅲ、Ⅳ级病变平扫CT和HRCT分级相仿(P>0.05)。结论HRCT对于AS骶髂关节早期病变的诊断优于平扫CT,而对于中度及重度关节炎的改变同平扫CT,诊断价值相同。     

刺五加注射液及抗凝剂对糖尿病足的早期干预治疗

目的观察刺五加注射液及抗凝剂(潘生丁、肠溶阿斯匹林)对糖尿病足早期干预治疗的影响。方法将符合1999年WHO诊断标准的100例糖尿病合并早期足病变的患者分为两组:干预治疗组50例,对照组50例。在控制血糖、血压、糖尿病教育的基础上,干预组予以静滴刺五加注射液及口服抗凝剂(潘生丁、肠溶阿斯匹林)治疗,对照组为口服VitB1、VitB6、复方丹参片治疗。观察治疗前后两组患者足背动脉搏动、皮肤颜色、温度,痛、温、触觉等相关指征,血糖、HbA1c、血TG、TC、HDL-C,及血流变学、眼底病变、心脑血管事件发生率等。结果干预组糖尿病足病变治疗好转率高,恶化发展率低,心脑血管事件发生率少。血脂、血流变学、下肢血管多普勒彩超及眼底病变等好转改善明显,与对照组比较差异有统计学意义(P<0.05或P<0.01)。结论刺五加注射液及抗凝剂(潘生丁、肠溶阿斯匹林)对糖尿病足病变的早期干预治疗疗效显著,有重要的临床意义。     

Die chirurgische Behandlung des Magenfrühcarcinoms

Zusammenfassung An der Chirurgischen Klinik Köln-Lindenthal wurden zwischen 1968 and 1983 94 Patienten, an der Klinik and Poliklinik für Allgemein- and Abdominalchirurgie Mainz zwischen 1972 and 1986 74 Patienten wegen eines Magenfrühcarcinoms operiert. Überlebensraten und Rezidivverhalten wurden abhängig von der operativen Therapie untersucht. In beiden Kollektiven war die Prognose des Mucosacarcinoms unabhängig von der durchgeführten Therapie günstig. Beim Submucosacarcinom war nach radikalchirurgischem Vorgehen die Häufigkeit von Rezidiven geringer und die Überlebensraten signifikant günstiger als nach alleiniger 2/3-Resektion. Die Ergebnisse sprechen für die Notwendigkeit eines radikalchirurgischen Vorgehens mit Dissektion der N2-Lymphknoten zumindest beim Submucosacarcinom des Magens.

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Surgical treatment of early gastric carcinoma

Summary At the department of surgery at the university hospital in Cologne 94 patients suffering from early gastric cancer of the stomach were operated in the years between 1968 and 1983. From 1972 till 1987 the department of surgery at the university hospital Mainz has had 74 patients. Survival rates and times without recurrence were calculated dependent on the surgical treatment carried out. In both collectives the prognosis for the patients with mucosal carcinoma was good no matter which operation was carried out. In the case of submucosal infiltration the frequency of recurrence was smaller and the survival rates significantly higher in those patients who subjected to a cancer operation than in those on whom only a resection of two third of the stomach was performed. The results indicate a radical approach in the treatment of early gastric cancer. At least in the case of submucosal carcinoma a dissection of the N2 lymph nodes is advisable.

     

后房型人工晶体植入术后早期并发症临床分析及处理

报告468例500眼后房型人工晶体植入术后2周内出现的并发症发生率,其中角膜水肿73.6％,色素膜炎症反应88.4％,瞳孔变形12.8％,人工晶体表面渗出膜3.8％,后囊混浊13.8％,短暂性高眼压5.2％,晶体皮质残留5.8％,人工晶体偏位2.6％,前房出血3％。提高术后视力的关键是提高手术技巧以减少并发症的发生。