原发鼻腔透明细胞癌3例及文献复习

目的:分析原发鼻腔部透明细癌胞的起源,病理,临床特点及治疗.方法:分析本院1992年9月～2003年9月收治的3例原鼻腔透明细胞癌患者资料,均有病理证实,中位年龄为60岁;主要症状为鼻塞逐渐加重,流涕,间断性流血涕,咽部不适等.3例均行放疗,1例为肿物切除术后放疗,1例初治放疗,1例肿物切除术后放疗后骨转移行化疗,采用6MV-X线治疗2例,8MV-X线治疗1例,DT 40Gy.结果:2例健在,1例死于呼吸,循环衰竭.结论:原发鼻腔部透明细胞癌较罕见,以局部浸润生长为主,发展迅速,可有淋巴道、血液转移,手术加放疗、化疗有效.     

Surgical relevance of diagnostic imaging techniques in pretherapeutic staging of carcinoma of the esophagus, stomach, colon and rectum

Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration, i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information. This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2) are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies, which may soon alter our therapeutic concepts.      

不同病理类型胃息肉流式细胞DNA定量研究

应用流式细胞计对５７ 例正常胃粘膜、不同病理类型的胃息肉和胃癌组织作ＤＮＡ 定量分析。正常胃粘膜、炎性息肉、增生性息肉、腺瘤性息肉及胃癌中，ＤＮＡ 非整倍体检出率分别为０％ 、７．７％ 、９．１％ 、３６．４％ 、５８．３％ ；各型胃息肉和胃癌组织的增殖期细胞比率均显著地高于正常胃粘膜组（Ｐ＜ ０．０１）；增生性或炎症性息肉组增殖期细胞比率与胃癌组比较，差异有显著性（Ｐ＜ ０．０５）或非常显著性（Ｐ＜ ０．０１），而腺瘤性息肉组增殖期细胞比率与胃癌组近似（Ｐ＞ ０．０５）。结果表明胃息肉是一种细胞增殖活跃性病变，其中腺瘤性息肉的ＤＮＡ 生物学行为更接近于胃癌，可能容易癌变；应用流式细胞ＤＮＡ 定量分析技术，结合组织病理学诊断，能对胃息肉的预后作出更为确切的判断     

替勃龙改善绝经期功能性消化不良症状

目的 :探讨替勃龙能否改善绝经期功能性消化不良患者临床症状及其相关机制。方法 :14 3例绝经期功能性消化不良患者随机分成 3组 ,分别给予替勃龙、西沙必利及替勃龙 +西沙必利 ,治疗 4周 ,观察治疗前后各组患者上腹胀痛、餐后胀满、早饱、暖气等临床症状积分的变化。在随机分成的 3组中再随机各抽出 2 0例患者治疗前后测定胃 30min排空率及胃半排空时间 ,观察治疗前后胃动力的变化。结果 :3组药物治疗后 2周和 4周上腹胀痛、餐后胀满症状积分均明显下降。西沙必利治疗后 2周和 4周对早饱、暖气症状无明显缓解 ,替勃龙及替勃龙 +西沙必利则对所观察的所有症状均有明显缓解 ,替勃龙改善早饱和嗳气症状优于西沙必利 ,但与西沙必利合用无增强效应。 3种药物治疗后 ,胃 30min排空率均明显增加、胃半排空时间缩短 ,与治疗前比较有显著差异 (P <0 .0 5 ) ,但 3种治疗方案之间无显著性差异 (P >0 .0 5 )。结论 :替勃龙能通过增强胃动力 ,明显改善部分绝经期功能性消化不良患者的临床症状 ,疗效优于促动力药。     

Leukemia clusters around nuclear facilities in Britain

He bas been retained for the defense by British Nuclear Fuelsplc in two suits in which leukemia and non-Hodgkin's lymphoma have been alleged to result from radiation exposures due to the operation of the nuclear reprocessing plant at Sellafield. This paper has been sent to the senior authors of the papers reporting clusters of leukemia or other malignancy in the vicinity of nuclear facilities in Britain and their comments invited. Subject to considerations of space and CCC style, these comments will be published as submited.     

痛力克对癌症疼痛镇痛效果的临床观察

应用印度ＬＵＰＩＮ公司提供的痛力克（酮酷酸氨丁三醇 ）对中重度癌症疼痛３０例进行镇痛效果的临床观察，有效率９３％，平均显效时间９ｍｉｎ，均数缓解时间５．１ｈ，并用哌替啶做了同期交叉自身镇痛对比研究，结果表明：两药的镇痛效果相似（Ｐ＞０．０５），但痛力克的不良反应发生率明显低于哌替啶。     

Comparison of p53 expression in proximal and distal gastric cancer: Histopathologic correlation and prognostic significance

Background: The overexpression of p53 has been found to be correlated with prognosis of some carcinomas, including gastric cancer, but no studies have reported on its relationship to the location of gastric cancer. In the present study, we compared the p53 expression of proximal and distal gastric cancer concerning histopathology and prognosis. Methods: A total of 170 tumors in the patients with proximal (80 cases) and distal (90 cases) gastric cancer were studied by immunohistochemical methods. Results: p53 immunopositivity was detected in 28.8% of all tumors. The p53-positive expression in proximal gastric cancer was higher than in distal gastric cancer (38.8% vs. 20.0%, p<0.05). A 5-year survival analysis showed that there is no significant difference between tumors that are p53 positive and p53 negative. No correlation was found between p53 expression and histopathology of gastric cancer. Conclusion: p53 nuclear staining is not useful as a prognostic indicator or as a parameter in gastric cancer.     

猴头菇发酵茶安全性检测及对大鼠胃酸分泌的影响

目的：检测猴头菇发酵茶的安全性并观察猴头菇发酵茶对大鼠胃酸分泌的影响。方法：猴头菇发酵茶安全性测定按GBl5193．1-94《食品安全性毒理学评价程序》要求进行；用酸度计测定大鼠胃液pH值。结果：猴头菇发酵茶对小鼠的半数致死量为15．11g／kg，且无诱发小鼠骨髓细胞微核形成，不同剂量的猴头菇发酵茶对大鼠胃酸分泌有促进和抑制的作用。结论：猴头菇发酵茶安全无毒，高剂量时对大鼠胃酸分泌有抑制作用。     

刘嘉湘教授辨治肝癌经验

辨治肝癌，依据肝脏的生理特点及肝癌的病理变化遣方用药。肝喜疏泄条达而恶抑郁，疏通气血是刘师治疗肝癌的基本法则。由于肝癌发生的实质在于肝脏的阴阳失去平衡，治疗的目的在于调和阴阳。临床上需根据疾病的症状及发展的不同阶段，采取补肝益气法、健脾理气法或养阴柔肝法，兼以解毒利湿、化瘀散结，达到补泻结合，取效良好     

Characterization of cell death events induced by anti-neoplastic drugs cisplatin, paclitaxel and 5-fluorouracil on human hepatoma cell lines: Possible mechanisms of cell resistance.

Two different hepatoma cell lines were incubated for 48h with chemotherapeutic drugs cisplatin, paclitaxel and 5-FU to determine their ability to induce cytotoxicity and DNA fragmentation as well as to modify the expression of some cell death-related genes that could be involved in the resistance to therapy. We observed that cisplatin and paclitaxel induced cytotoxicity, but significant differences between both cell lines, were found only in the case of paclitaxel. At 48h, apoptosis was clearly present in Hep3B cells treated with cisplatin and HepG2 cells treated with paclitaxel. 5-FU induced cytotoxicity in both cell lines but only at higher concentrations than the other two drugs, triggering apoptosis and necrosis in HepG2 cells and only necrosis in Hep3B. When a time course was performed for the first 8h of treatment to elucidate the initial mechanism of cell death responsible for DNA fragmentation, we observed that 5-FU in Hep3B, and cisplatin in both cell lines, induces primary necrosis, whereas at the concentration tested here, paclitaxel clearly triggers apoptosis in both cell lines. HepG2 cells were weakly sensitive to 5-FU in the first 8h of treatment, so the primary mechanism of cell death was not clear, but results seem to indicate that it could be apoptosis. At 48h, Bax was not up-regulated with any of the treatments, whereas cisplatin was able to induce Bcl-xL down-regulation in both cell lines. Treatment with 5-FU also down-regulated Bcl-xL in HepG2 cells. We also measured variations in the expression of survivin, an inhibitor of apoptosis that has also been involved in mitototic catastrophe. Hep3B cells seem to show an increase in protein levels with all treatments. Exposure to paclitaxel resulted in the highest effect. In the case of HepG2 cells, there was a decrease in survivin expression when cells were treated with 5FU and paclitaxel, both treatments showing complete loss of the protein. Using an antibody that recognizes unprocessed caspase-3, we observed that the enzyme was assumingly activated in HepG2 cells treated with 5FU and paclitaxel, but only weakly after treatment with cisplatin. Hep3B cells did not show activation since the levels of the pro-enzyme remained the same as that in the control. In conclusion, the three drugs tested in this study could induce cell death, with paclitaxel being more effective inducing apoptosis. 5FU was only effective at high doses and its mechanism seems to be primarily related to necrosis in Hep3B and probably apoptosis in HepG2. Cisplatin mechanism of cell death is probably mediated by the decrease in anti-apoptotic protein Bcl-xL whereas paclitaxel and 5FU are decreasing the apoptosis inhibitor survivin. According to pro-enzyme levels, caspase-3 was only activated in HepG2 cells, whereas in the case of Hep3B cells the mechanisms of toxicity appear to be caspase-3-independent at the time and concentrations tested in this study. The resistance of Hep3B cells to death induced by chemotherapy could be related to an increase in the expression of IAP survivin, which can decrease cell response to the treatment or even switch the type of death from apoptosis to another kind, making therapy less efficient.