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。     

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。     

Effect of Helicobacter pylori on ectopic gastric mucosa of Meckel's diverticulum in children after meckelectomy

Ninety-two children underwent meckelectomy in our department over the 10-year period 1981–1990. All histologic speciments of Meckel's diverticula were studied, most of them retrospectively, for evidence of active inflammation or ulceration in any ectopic gastric mucosa present and specifically searching for Helicobacter pylori (HP). Thirty-eight (group A) were excised as being responsible for the main clinical symptoms while 54 (group B) were resected incidentally. Ectopic gastric mucosa was found in 19 cases, 18 in the symptomatic group and 1 in the incidental group. In the 18 cases belonging to group A histologic findings indicating gastritis due to HP were present. Combined operative and laboratory findings in all 92 cases indicated that HP colonizes gastric mucosa electively and leads to infection, which seems to be responsible for the clinical symptoms of meckelitis.Presented at the 15th Annual International Meeting of Greek Association of Pediatric Surgeons, Porto Hydra, Greece, 27–30 September 1990     

人胃癌组织中fibulin-5的表达及其临床意义

目的探讨fibulin-5在人胃癌组织中的表达及其临床意义。方法采用免疫组织化学染色结合图像分析法，对32例胃癌组织、癌旁组织及正常胃组织中fibulin-5的表达进行半定量分析。结果fibulin-5在胃癌组织中的表达强于癌旁组织和正常组织（P〈0．05），且表达强度与癌组织的分化程度有关，低分化癌组织的fibulin-5表达强（P〈O．05）。结论fibulin-5的表达可能与胃癌组织细胞的恶性转化及增殖有关。     

美宝胃肠胶囊治疗胃炎和溃疡病的临床观察

目的：探讨美宝胃肠胶囊修复胃炎、胃溃疡等胃肠黏膜病变的治疗作用。方法：随机将40例具有胃黏膜病变的患者（慢性胃炎患者25例，消化性溃疡15例）分为两组：治疗组服用美宝胃肠胶囊及奥美拉唑治疗；对照组单用奥美拉唑治疗，根据临床症状改善情况及胃镜下黏膜修复情况综合评价疗效，并进行组间比效。结果：美宝胃肠胶囊联合奥美拉唑治疗组病人的临床症状改善率，优于单纯接受奥美拉唑治疗的对照组，治疗组的胃镜下病灶修复状况也优于对照组。结论：美宝胃肠胶囊对胃黏膜病变的修复与症状改善有良好的治疗作用。     

Survivin和bFGF在胃癌及肠化生组织中的表达及其与胃癌血管生成的关系

目的探讨Survivin和bFGF在胃癌及肠化生组织中的表达及其与胃癌血管生成的关系,为胃癌的诊断、治疗及预后判断提供依据。方法应用免疫组化S-P法检测44例胃癌组织、22例肠化生组织和10例正常胃黏膜组织中的Survivin、bFGF的表达和MVD值,分析Survivin、bFGF表达、MVD值与临床病理因素间的关系。结果在44例胃癌组织、22例肠化生组织和10例正常胃黏膜组织中Survivin、bFGF和MVD3种标记物在3组组织之间差异有统计学意义(P<0.05)。在胃癌组织中Survivin、bFGF表达及MVD值均与肿瘤浸润深度、淋巴结转移、TNM分期有关(P<0.05)。胃癌组织中Survivin和bF-GF表达与MVD值均有相关性(P<0.05)。胃癌组织中Survivin和bFGF两者均阳性组中MVD值与两者均阴性组相比差异有统计学意义(P<0.05)。结论胃癌组中Survivin、bFGF的表达均与MVD值有明显相关性,bFGF和Survivin的表达共同促进胃癌血管的生成。联合检测Survivin、bFGF和MVD有助于对胃癌的病理分级、恶性程度判定和预后判断。