巨大淋巴结增生症2例并文献复习

Castleman disease(CD)又称血管滤泡性淋巴结增生,是一种少见特殊的慢性淋巴组织增生性疾病,发生于腹膜后及肾周者尤其少见.临床容易误诊为恶性淋巴瘤、淋巴结炎、异位胸腺瘤等疾病.本病主要靠组织病理学诊断,现报道2例.     

Effects of hyperbaric oxygen on TF、TNF-α in the rabbit model of steroid-induced avascular osteonecrosis of femoral head

Objective To investigate dynamic changes in serum TF and TNF-α in the rabbit model of steroid-induced avascular osteonecrosis of femoral head ( SANFH) and also to explore the mechanism of SANFH, as well as effects of hyperbaric oxygen ( HBO) on SANFH. Methods Seventy-eight New Zealand male rabbits were randomly divided into 3 groups:the normal control (group N) (7 animals), the model group (group M) (41 animals) and the HBO group (group H) (30 animals). The model group was subdivided into the immediate model group (the M0 group) (10 animals), the two-week model group (the M2 group) (10 animals), the four-week model group (the M4 group) (10 animals) and the six-week model group (the M6 group) (11 animals). The HBO group was further divided into the 2-week HBO therapy group (HBO2) (7 animals), the 4-week HBO therapy group (HBO4) (11 animals) and the 6-week HBO therapy group (HBO6) (12 animals). Through injection of endotoxin and methyl-prednisolone, rabbits in the group HBO2, HBO4 and HBO6 received HBO therapy 1 hour daily from the second day of the experiment. The durations of HBO therapy were 2 weeks ( HBO2), and 4 weeks respectively. The animals were sacrificed after blood samples were taken at respective blood collection time. Then, levels of TF, TNF-α in the serum were measured and the histological changes in the femoral heads were observed. Results Levels of TF and TNF-α in group M0 increased significantly, when compared with those of group N (P ＜0. 05 or P ＜0.01), while for the HBO subgroups the expression of TF and TNF-α measured at the same time points all decreased, when compared with that of the model subgroups (P＜0. 05 or P ＜0.01). To elaborate, TF levels in group M2 and M4 were much higher than those in group HBO2 and HBO4 ( P＜0. 01 ). TF level in group M6 was higher than that in group HB06 ( P ＜ 0.05). TNF-α in group M0 also increased significantly, when compared with that in group N( P ＜0.01). TNF-α levels in group M2 and M6 were also much higher than those in group HBO2 and HBO6 ( both P ＜0. 01 ). TNF-α in group M4 was higher than that in group HBO4 (P＜0.01). Histological examination revealed that tissues of the femoral heads in group N were normal, osteonecrosis and thrombus could be noted in group M2 and M4, hyperplasia fibrosis could be found in group M6, and osteonecrosis in HBO2 and HB04 groups seemed less severer than that in M2 and M4 groups, no thrombi in HBO2, HBO4 groups were noted, and growth of new bones were detected in HBO4 and HBO6. Conclusions The levels of TF and TNF-α levels increased in the rabbit model of SANFH, inducing blood coagulation. Thrombosis at the femoral heads was one of the causes of SANFH. HBO therapy could inhibit the release of TF and TNF-α, thus improving the abnormality of blood coagulation and enhancing treatment of osteonecrosis.     

恶性纤维组织细胞瘤的诊治体会(附7例报告)

目的 总结7例恶性纤维组织细胞瘤的临床病理特点、治疗方法和预后.方法 回顾性分析7例恶性纤维组织细胞瘤患者的临床和病理资料,并结合国内外文献进行分析.结果 7例患者表现为进行性消瘦、肿块、疼痛,术后免疫组化证实为恶性纤维组织细胞瘤.行根治性手术切除后,未见复发.4例患者术后死于肺转移,3例患者无瘤存活至今.结论 恶性纤维组织细胞瘤术前诊断困难,免疫组化技术有助于确诊.早发现、早期行根治性手术是提高治愈率、减少复发和延长生存时间的关键.     

血管内皮生长因子及其受体在胃肠间质瘤中的表达

1983年Mazur[1]首次提出胃肠道间质瘤(gastrointestinalstromal tumors,GISTs)的诊断以后,作为一种独立的消化道疾病一直是研究热点。GIST可发生自食管至肛门的胃肠道全长范围,瘤细胞显示CD117及CD34有较高的阳性表达率[2,3]。血管内皮生长因子(VEGF)及其受体(VEGFR-2)被认为是     

胃肠道间质瘤40例临床病理分析

目的探讨胃肠道间质瘤(GIST)的基本临床病理、良恶标准、组织学类型、预后的判断以及组织发生等问题.方法对我院1999～2004年曾被诊断为胃肠道间质瘤的40例患者进行临床和病理分析.结果 40例中胃恶性间质肿瘤16例,小肠恶性间质肿瘤15例,大肠肿瘤3例,盆腔肿瘤3例,后腹膜肿瘤2例,食道肿瘤1例.肿瘤大小0.2～25 cm,平均7.8 cm.其中4例发生了转移.免疫组化的阳性表达结果:CD117阳性率为90.0%,CD34阳性率45.0%,S-100阳性率10.0%,VEGF阳性率70.0%,VEGFR-2阳性率80.0%.其中CD117与CD34共表达率为40.0%(16/40),CD117与S-100共表达率为7.5%(3/40),CD34与S-100共表达率为2.5%(1/40).结论 GIST的主要恶性指标有肿瘤最大径、核分裂像(HPF).在GIST的诊断中,只要CD117表达即可诊断为狭义的GIST,并将真正的平滑肌肿瘤与雪旺细胞瘤区别出来.VEGF也是一种衡量肿瘤生长和转移的重要指标.     

改革护技实验教学提高护生操作技能

目的探讨改革护理技术实验课教学方法，提高护理探作技能水平。方法选择2002级英护专业2个教学班为实验班，随机将1班作实验班，2班为对照班，对照班用传统的方法教学，实验班进行实验教学改革。期末时比较2个班护生护技操作技能水平。结果护技探作技能实验班明显高于对照班（P〈0．01）。结论根据实验课的教学内容，恰当地采用不同的教学方法。能够提高护理探作技能水平。     

高压氧对激素性股骨头坏死兔血中TF、TNF-α的影响

目的 通过研究激素性股骨头坏死(steroid-induced avascular necrosis of the femoral head,SANFH)兔血组织因子(TF)和肿瘤坏死因子(TNF-α)的动态变化及高压氧(hyperbaric oxygen,HBO)对其影响,探讨SANFH发生机制和高压氧治疗的作用机制.方法 健康新西兰白兔78只,按数字随机表法分为3组:正常对照组(N组)7只,模型组(M组)41只,高压氧组(HBO组)30只.模型组又分为造模即刻组(M0组)10只,造模2周组(M2组)10只、造模4周组(M4组)10只、造模6周组(M6组)11只.HBO组分为:2周HBO组(HBO2组)7只、4周HBO组(HBO4组)11只、6周HBO组(HBO6组)12只.采用注射内毒素加甲强龙的方法对模型组及HBO组进行造模处理,HBO组在制模后开始HBO处理,每天1次,并于制模2周、4周、6周分别取静脉血检测TF、TNF-α的变化,于相应取血时间点取血后处死实验动物,取双侧股骨头组织进行组织学观察.结果 M各组TF[M0:(281.42±46.71)pg/ml,M2:(242.25±131.87)pg/ml,M4:(176.39±66.39)pg/ml,M6:(121.32±107.70)pg/ml]、TNF-α[M0:(418.83±75.99)pg/ml,M2:(424.41±57.01)pg/ml,M4:(424.05±136.44)pg/ml,M6:(344.34±112.89)pg/ml]均高于N组[TF:(137.55±21.65)pg/ml,TNF-α:(312.17±31.12)pg/ml],P＜0.05或P＜0.01;而HBO各组与M各组同时间点比较其表达均降低,P＜0.05或P＜0.01;组织学结果:N组股骨头组织形态正常,M组股骨十骺端髓腔内骨髓组织脂肪细胞增多增大、可见变性及片状坏死、炎性细胞浸润、出血、水肿及微小血管血栓、骨髓腔纤维化、造血细胞减少、股骨头萎缩明显;HBO各组脂肪变性、坏死出现率与M组比较明显减少,骨小梁间骨髓炎症反应明显减轻,未见到血栓形成,可见到骨母细胞活跃增生、骨髓纤维化、新生骨形成、股骨头萎缩不明显、骨基质正常.结论 兔SANFH时血中TF、TNF-α含量增高,诱导了体内凝血反应,使股骨头处血栓形成,HBO治疗可抑制实验动物体内TF、TNF-α的释放,从而改善凝血功能的异常,治疗股骨头坏死.

Abstract：

Objective To investigate dynamic changes in serum TF and TNF-α in the rabbit model of steroid-induced avascular osteonecrosis of femoral head ( SANFH) and also to explore the mechanism of SANFH, as well as effects of hyperbaric oxygen ( HBO) on SANFH. Methods Seventy-eight New Zealand male rabbits were randomly divided into 3 groups:the normal control (group N) (7 animals), the model group (group M) (41 animals) and the HBO group (group H) (30 animals). The model group was subdivided into the immediate model group (the M0 group) (10 animals), the two-week model group (the M2 group) (10 animals), the four-week model group (the M4 group) (10 animals) and the six-week model group (the M6 group) (11 animals). The HBO group was further divided into the 2-week HBO therapy group (HBO2) (7 animals), the 4-week HBO therapy group (HBO4) (11 animals) and the 6-week HBO therapy group (HBO6) (12 animals). Through injection of endotoxin and methyl-prednisolone, rabbits in the group HBO2, HBO4 and HBO6 received HBO therapy 1 hour daily from the second day of the experiment. The durations of HBO therapy were 2 weeks ( HBO2), and 4 weeks respectively. The animals were sacrificed after blood samples were taken at respective blood collection time. Then, levels of TF, TNF-α in the serum were measured and the histological changes in the femoral heads were observed. Results Levels of TF and TNF-α in group M0 increased significantly, when compared with those of group N (P ＜0. 05 or P ＜0.01), while for the HBO subgroups the expression of TF and TNF-α measured at the same time points all decreased, when compared with that of the model subgroups (P＜0. 05 or P ＜0.01). To elaborate, TF levels in group M2 and M4 were much higher than those in group HBO2 and HBO4 ( P＜0. 01 ). TF level in group M6 was higher than that in group HB06 ( P ＜ 0.05). TNF-α in group M0 also increased significantly, when compared with that in group N( P ＜0.01). TNF-α levels in group M2 and M6 were also much higher than those in group HBO2 and HBO6 ( both P ＜0. 01 ). TNF-α in group M4 was higher than that in group HBO4 (P＜0.01). Histological examination revealed that tissues of the femoral heads in group N were normal, osteonecrosis and thrombus could be noted in group M2 and M4, hyperplasia fibrosis could be found in group M6, and osteonecrosis in HBO2 and HB04 groups seemed less severer than that in M2 and M4 groups, no thrombi in HBO2, HBO4 groups were noted, and growth of new bones were detected in HBO4 and HBO6. Conclusions The levels of TF and TNF-α levels increased in the rabbit model of SANFH, inducing blood coagulation. Thrombosis at the femoral heads was one of the causes of SANFH. HBO therapy could inhibit the release of TF and TNF-α, thus improving the abnormality of blood coagulation and enhancing treatment of osteonecrosis.     

附睾结节样病变133例临床病理分析

目的探讨附睾常见肿瘤及肿瘤样病变的临床病理特征。方法对133例经手术切除的附睾病变的临床和病理资料进行回顾性分析,对8例炎性假瘤和伴有结节状增生的附睾炎进行免疫组化检查。结果肿瘤性病变12例(9%),囊肿29例(21.8%),结核21例(15.8%),精子肉芽肿13例(9.8%),非肉芽肿性附睾炎40例(30.1%),炎性假瘤、纤维性假瘤及平滑肌增生结节18例(13.5%)。结论附睾肿瘤样病变中真性肿瘤只占少数,肿瘤样病变多数由附睾炎引起,病变形态多样。     

高压氧对激素性股骨头坏死兔血中IL19、IL20的影响

目的 研究高压氧(HBO)对激素性股骨头坏死(steroid-induced avasculal osteoecrosis of femoral head,SANFH)兔血中白介素19、20(interleukin-19、20,IL19、IL20)的影响.方法 健康新西兰白兔78只,随机分为3组:正常对照组(N组)7只,模型组(M组)41只,HBO组30只.M组又分为造模完成组(M0组)10只,造模2周组(M2组)10只,造模4周组(M4组)10只,造模6周组(M6组)11只.HBO组分为2周HBO组(HBO2组)7只,4周HBO组(HBO4组)11只,6周HBO组(HBO6组)12只.采用注射内毒素加甲基强的松龙的方法对模型组及HBO组动物进行造模处理,HBO 组在造模完成后开始HBO处理,1次/d,于造模2、4、6周分别取静脉血检测IL19、IL20的变化,并于取血后处死动物,取双侧股骨头进行组织形态学观察.结果 IL19表达:M0组明显增高,与N组比较差异有统计学意义(P＜0.05);M2、M4组表达较M0组下降,但M2组比HBO2组、M4组比HBO4组的表达高,差异有统计学意义(P＜0.01或P＜0.05).IL20表达:M0组明显增高,与N组比较差异有统计学意义(P＜0.05);M2组的表达较M0组下降,但比HBO2组表达高,差异具有统计学意义(P＜0.05);M4组与HBO4组比较差异无统计学意义(P＞0.05);M6组表达较M4高,HBO6组继续下降,与M6组比较差异有统计学意义(P＜0.05).病理结果:N组股骨头组织形态学正常;M2、M4组可见不同程度的骨髓腔内脂肪细胞变性及坏死,周围有淋巴细胞为主的炎性细胞浸润;M6组表现为骨髓腔纤维化,成骨表现活跃.HBO治疗2周后,股骨头骨细胞核未见明显固缩,骨小梁间骨髓炎症反应明显减轻,骨母细胞及纤维组织增生,治疗4～6周骨母细胞活跃增生,成骨形成.结论 SANFH时兔血中IL19、IL20含量增高,炎症反应是SANFH的病因之一.HBO治疗可抑制IL19、IL20的释放,减轻炎症反应,从而减轻股骨头坏死的程度.     

博来霉素致大鼠肺纤维化模型肺组织的动态病理变化及其发生机制

目的： 了解博来霉素（BLM）致大鼠肺纤维化模型肺组织的动态病理变化,探讨BLM致肺纤维化的作用机制。方法：60只雄性SD大鼠采用随机数字表法分为正常对照组（N组）和肺纤维化模型组（B3、B7、B14、B28、B56组）,每组10只。除N组外,其余各组采用气管内注入BLM致大鼠肺纤维化模型, 分别于3、7、14、28、56 d处死各组大鼠,右肺行苏木精-依红（HE）、Masson胶原及天狼猩红染色,测定左肺羟脯氨酸（HYP）的含量。 RT-PCR法半定量测定转化生长因子-1（TGF-β1）、基质金属蛋白酶-9（MMP-9）和基质金属蛋白酶组织抑制物-1（TIMP-1）mRNA在肺内的表达。免疫组化法观察TGF-β1、MMP-9及TIMP-1蛋白在大鼠肺组织的表达。结果：(1) 模型组大鼠肺组织HYP含量显著高于N组（P<0.05）,模型组大鼠肺组织肺泡炎症的程度也明显重于N组,B14、B28和B56组大鼠肺纤维化的程度明显重于N组,大鼠在灌注BLM后不同时点其肺组织有着不同的病理变化。 (2) TGF-β1、MMP-9及TIMP-1在正常组大鼠肺脏中即有表达,但表达较弱,灌注BLM后它们的表达均增强,不同时点它们在肺组织内的分布有不同的特点。结论：给予后不同时点大鼠肺组织有着不同的病理变化特点,TGF-β1、MMP-9和TIMP-1在BLM诱导的肺纤维化形成过程中起着重要的调节作用。