HSV-tK与IL-2基因对涎腺多形性腺瘤细胞的杀伤作用

目的:观察腺病毒介导的单纯疱疹病毒胸苷激酶基因(HSV-tK)和白细胞介素-2基因(IL-2)联合杀伤人涎腺多形性腺瘤细胞的效果.方法:采用腺病毒介导的HSV-tK基因和IL-2基因联合转染人涎腺多形性腺瘤细胞;采用逆转录聚合酶链式反应(RT-PCR)检测转染后细胞的基因表达;采用四唑盐比色(MTT))法测定tK与IL-2基因对肿瘤细胞的杀伤作用及旁观者效应:采用光镜观察基因治疗后肿瘤细胞的形态学变化.结果:单独转染HSV-tK/GCV及IL-2基因5天后,涎腺多形性腺瘤细胞的存活率分别为37.7%和66.0%:联合转染5天后,细胞的存活率降至21.5%,与前二者相比差异有显著性(P＜0.05).结论:HSV-tK和IL-2基因联合使用对涎腺多形性腺瘤的杀伤作用高于上述基因单独使用的杀伤作用.     

Proliferation, Vascular Endothelial Growth Factor Expression and Cavernous Sinus Invasion in Growth Hormone Secreting Pituitary Adenomas

Summary  Surgical cure of growth hormone producing pituitary adenomas (GHomas) becomes difficult when they invade the cavernous sinus (CS). Tumour proliferative activity and angiogenesis are thought to be required for tumour growth and invasion, and vascular endothelial growth factor (VEGF) activates neovascularization around tumours. In this study, the mechanism and clinical significance of CS invasion is analysed. In 25 surgically treated GHomas, the extent of CS invasion was classified as high (Knosp's grade 3 and 4), and low (grade 0, 1 and 2) MR grades, and the MR grades were compared with tumour proliferative potential (Ki-67 expression), angiogenetic demand (VEGF expression), volume of adenomas and serum hormone levels.  The Ki-67 index of high MR grade adenomas (1.17±0.62%) was significantly higher than that of low MR grade adenomas (0.55±0.42%, p=0.027), whereas VEGF expression showed no significant correlation with MR grades (p>0.999). Tumour volume also showed a significant correlation with MR grade (p=0.002). VEGF expression was not correlated with serum hormone level and volume, but was correlated with tumour proliferative potential. Proliferative potential and tumour volume were two independent factors related to CS invasion. Although VEGF expression was not a direct factor related to CS invasion, it may indirectly play a role in activation of tumour aggressiveness, which is required in CS invasion.  Our results show that high MR grade adenomas have higher proliferative ability. In order to improve the surgical outcome, pre-operative medical debulking is indicated, particularly, in such adenomas.     

The Value of Intraoperative Cytology During Transsphenoidal Surgery for ACTH-Secreting Microadenoma

Summary  Background. Microsurgical selective adenomectomy is the best established method available for the treatment of Cushing's disease. However, this surgical method warrants still more efforts to improve the results in minute microadenomas. In this paper the authors evaluate a method of intraoperative cytological investigations during transsphenoidal surgery.  Method. Between January 1997 and September 1999, transsphenoidal surgery was performed in 75 patients with the diagnosis of Cushing's disease. Fifty-one cases of proven microadenomas were reviewed.  Findings. Of 51 cases, 33 tumors were 3 mm or less in diameter, here after called minute adenomas. In 49 of 51 (96.1%) microadenomas, adenoma tissue was identified by intraoperative cytological techniques. Postoperatively, only 35 of 51 ACTH-secreting microadenomas (68.6%) were confirmed by immunostaining methods. This lower percentage was most probably due to the small amount of tissue obtained. Therefore, in 14 cases (including 12 minute adenomas) the presence of the adenoma was only proven by cytological preparation and clinical outcome. The sensitivity of cytological preparations in cases of confirmed Cushing's disease was 100%.  Interpretation. The method described here was particularly well suited for the intraoperative discrimination and documentation of minute adenomas. Cytological preparation appears to be effective in improving the adenoma finding rate and the surgical outcome in cases of Cushing's disease.     

伽玛刀治疗垂体腺瘤的效率及其作用地位探讨

目的：从一个侧面探讨伽玛刀的作用地位。方法：采取“伽玛刀”和“开颅手术”两治疗方法对垂体腺瘤治疗的住院日、治疗率、后续治疗率，以及病人收治数量的变化等方面进行对比分析。结果：在239例垂体腺瘤的治疗中，伽玛刀治疗的平均住院日只是开颅手术的31．40％，治疗率占64．85％，后续治疗率2、58％(开颅手术为38．10％)，病人收治数量明显增加。结论：伽玛刀在医疗绩效中的作用明显。     

尿毒症肾性骨病继发甲状旁腺腺瘤的诊治探讨

目的　探讨尿毒症肾性骨病继发甲状旁腺腺瘤的诊治方法、疗效及预后。方法　比较罗钙全冲击治疗、甲状旁腺腺瘤切除术两种治疗方式的疗效及预后。结果　罗钙全冲击治疗后 ,患者病情反而加重 ;未行正规治疗 ,疾病进展至晚期或钙化防御者 ,不可逆转 ;行甲状旁腺腺瘤切除术者 ,短期效果良好。结论　甲状旁腺功能亢进应强调早期诊断 ,治疗方案要个体化、正规化。治疗上 ,罗钙全等活性维生素D3 冲击治疗效果不佳 ,甲状旁腺腺瘤切除术短期效果明显 ,且理论上不会导致甲状旁腺功能低下 ,是一种有选择价值的治疗方法     

颅外垂体移植术供体细胞的培养研究

目的 本实验通过对人垂体腺瘤细胞体外培养实验，证实培养技术的可靠性和可重复性；为颅外移植术应用垂体腺瘤细胞作为移植物供体细胞的实施，以及为腺垂体移植细胞库的建立提供有用的实验依据。方法 利用手术切除的人垂体腺瘤组织做体外培养，动态观察培养细胞的生长状态，通过放免测定和免疫化学染色技术，评价体外培养的垂体细胞的功能状态。结果 人垂体腺瘤细胞经体外培养仍具有分泌激素的功能，6例GH腺瘤均有大量GH分泌，5例PRL腺瘤分泌大量PRL，3例无功能腺瘤细胞培养液中分别有不同程度的FSH及LH、PRL分泌。结论 培养成功的14例人垂体腺瘤细胞在体外均具有激素分泌功能。为应用垂体腺瘤细胞为移植物供体，进行颅外移植的研究提供了有用的实验基础。     

Treatment and Prognosis of Pituitary Adenomas in Children

In order to explore the treatments and prognosis of pituitary adenomas in children, the experience in the treatment of 15 children with pituitary adenomas was summed up. The clinical data of 15 children with pituitary adenomas in Tongji Hospital were retrospectively analyzed from Jan. 1997 to Aug. 2004, including 9 males and 6 females with the age ranging from 9-15 years old （mean 12.8）. The disease duration was 3 months to 5 years （mean 2 years）. Fourteen cases were subjected to the microsurgical operation through oral tanssphenoidal approach and one case to medical treatment. All cases were followed up from 1 to 5 years by imaging studies and endocrine investigation. The results showed that 13 eases obtained total removal of the tumor and one subtotal removal of tumor. No severe complications and operation death occurred. It was concluded that the tanssphenoidal approach was the optimal treatment for children with pituitary adenomas. Regular and long-term follow-up is of great importance.     

彩色多普勒超声在诊断结节性甲状腺肿的应用价值

目的:探讨高频超声声像图和彩色多普勒血流图对结节性甲状腺肿的诊断价值.方法:对31例甲状腺肿的结节进行仔细观察,评价二维图象和彩色多普勒血流图的表现.结果:超声诊断与病理诊断的符合率为68%,实质性及囊实性结节性甲状腺肿的结节表现无包膜或包膜不完整,周边无明显的晕环.结节内部及周边血供不丰富,边缘无环形血流,呈星点状或结节间穿行血流,彩色多普勒能量图,在结节血流显示上优于彩色多普勒血流图.结论:应用彩色多普勒超声对结节性甲状腺肿能够提供重要的血流信息,有助于结节性甲状腺肿的诊断及鉴别诊断,对提高超声诊断正确率有重要意义.     

再次经鼻蝶入路切除复发或残留的垂体瘤

目的：探讨经鼻蝶手术后复发或残留的垂体瘤再次经单鼻孔直达蝶窦入路显微外科手术的技术方法与疗效。方法：我科2001年8月至2005年8月对经鼻蝶手术后复发或残留的32例垂体瘤进行了经单鼻孔直达蝶窦入路显微外科再次手术治疗。结果：14例（43．8％）肿瘤获全切除，10例（31．2％）肿瘤达到次全切除，8例（25．0％）肿瘤仅获部分切除，无手术死亡。在垂体激素异常增高的13例功能性垂体腺瘤中，6例激素水平降至正常，3例激素水平下降〉50％，4例激素水平下降〈50％。24例术后随访观察6—48个月，8例（8／9）头痛消失或减轻；21例（21／22）视力、视野障碍改善；5例（5／7）肢端肥大症减轻；3例（3／4）溢乳停止，月经恢复。结论：经单鼻孔直达蝶窦入路显微外科手术最大限度的利用了鼻腔的自然间隙，具有入入路直接、创伤轻微和并发症少等优点；尽管有一定难度，但仍然是治疗经鼻蝶手术后复发或残留垂体瘤的一种安全有效的微创方法。     

原发性醛固酮增多症临床特点及术前诊断方法评价

目的 观察乌司他丁对脓毒症患者的抗炎作用。方法 将80例脓毒症患者随机分为治疗组与对照组，两组给予综合常规治疗，治疗组在综合治疗的基础上给予乌司他丁，观察两组治疗前后外周血降钙素原（PCT）、C-反应蛋白（CRP）和WBC水平变化及并发症的发生情况。结果 治疗组治疗后外周血PCT、CRP和WBC水平明显下降，而对照组则变化不大；治疗组并发症发生率明显低于对照组。结论 乌司他丁对脓毒症患者炎症因子具有拮抗作用，可阻断全身炎症反应综合征的病理反应过程，改善脓毒症患者的预后。