第二原发胰腺癌临床特征分析

目的:探讨第二原发胰腺癌的临床特征.方法:以96例普通原发胰腺癌作为对照,回顾性分析了病理确诊的32例第二原发胰腺癌的临床特征.结果:32例第二原发胰腺癌15例(46.9％)发生于乳腺癌、胃癌之后.性别、年龄、部位、临床症状、常规实验室检查及肿瘤标志物检测与普通进展期胰腺癌具有可比性,仅年龄略为提前,消化不良稍多,腹痛、黄疸比例稍降.B型超声、CT、MRI、逆行胰胆管造影诊断敏感率较普通胰腺癌高.处于Ⅰ期者仅2例(6.3％).总体半年存活率为50.0％,较普通胰腺癌略低.病理显示84.4％为腺癌,分化差.结论:第二原发胰腺癌症状更不典型,诊断更为滞后,预后更差,故应加强联系与第一次癌肿的早期检测手段(如肿瘤标志物)研究.     

PERFORATED PEPTIC ULCER IN THE HUNTER REGION: A REVIEW OF 174 CASES

A review of 174 consecutive patients admitted with a diagnosis of perforated peptic ulcer to eight Hunter Region hospitals during 1979–86 is presented. Among the female admissions, the proportion of patients > 70 years of age was twice that in males. One-third of all perforations were in females who accounted for two-thirds of all perforated gastric ulcers. Multivariate analysis revealed that perforations located in the stomach and older age were both significant independent variables adversely affecting outcome following surgery. In contrast, shock at presentation and delay in operating were not statistically significant independent risk factors.     

原发性膀胱腺癌临床病理分析

对６例原发性膀胱腺癌进行临床病理分析，患者年龄４０～７６岁，男４例，女２例。术前病程多为２个月，以血尿症状为主。６例均经病理检查证实，其中４例加做ＰＡＳ染色，证实有ＰＡＳ阳性物质，免疫组化标记ＣＥＡ４例，有３例呈阳性结果。本组随访结果５例死亡，存活时间９～４３月，１例尚存活１３月。结合文献着重讨论了影响膀胱腺癌预后诸因素。     

Carcinoma of the male breast: Analysis of prognosis compared with matched female patients

Background: Considerable debate exists concerning the prognosis of breast cancer in male patients compared with that in female patients. Some studies have observed worse prognosis for men; others suggested the higher mortality rates were primarily due to delayed diagnosis. Methods: Survival time from diagnosis with invasive disease to death resulting from breast cancer of 58 men treated between 1973 and 1989 was compared with survival of 174 women treated between 1976 and 1978 who were matched by stage of disease and age at diagnosis. All patients were treated by mastectomy and axillary dissection. Results: Tumors were ⩽2 cm in 70% of cases and 55% were free of axillary metastases. The histology of the tumors differed significantly by gender (p<0.05). Significantly more men had estrogen receptor-positive tumors (87%) than did women (55%, p<0.001). Survival at 10 years was similar for male and female patients. Multivariate analysis controlling for tumor size, number of positive axillary lymph nodes, age at diagnosis, histology, and receptor status indicated no significant difference in survival of male compared with female patients. Conclusions: These data conflict with the conventional wisdom that breast cancer in men carries a worse prognosis than the disease in women. Although histology of the tumor and receptor status differed by gender, these factors did not have an impact on survival in these paired patients. Our data indicate that breast carcinoma in males is not biologically more aggressive than in females. Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

颅脑损伤患者伤后细胞免疫功能变化及黄芪的免疫调节作用

目的：研究颅脑损伤患者伤后细胞免疫功能的变化规律及黄芪对细胞免疫功能的调节作用。方法：73例中、重型颅脑损伤患者随机分为常规治疗组35例和黄芪治疗组38例。对照组10例。采用放射免疫法．双抗体夹心酶联免疫吸附法及碱性磷酸酶法于不同时间检测各组患者细胞免疫学指标，1个月后进行疗效评价，并进行统计学处理。结果：颅脑损伤患者伤后1d IL-2、CD4、CD4／CD8显著下降，SIL-2R及CD8显著升高(P＜0．01)。伤后第30天常规组与黄芪组比较IL-2，SIL-2R，CD8、CD4／CD8有显著性差异，CD4无显著性差异。伤后1月两组患者感染发生率、GCS评分、日常生活能力比较有显著性差异(P＜0．01)。结论：中、重型颅脑损伤息者伤后存在显著的细胞免疫功能抑制，黄芪可以改善患者细胞免疫功能状态，提高机体抗感染能力．改善预后。     

胃癌肝转移肝切除的预后分析

目的分析胃癌肝转移后实施肝切除患者的预后因素。方法对1996~2003年间实施肝切除的45例胃癌肝转移患者的临床资料进行回顾性研究,分析临床病理学指标与患者生存期之间的关系。结果45例接受肝切除的患者有2例死于术后严重并发症。获得随访的39例患者的1,3,5年的总体生存率分别为54%,32%和21%。中位生存时间为29.5月,6例患者存活时间超过5年。胃周淋巴结转移、侵袭深度、辅助化疗、肝脏转移灶数目以及胃癌患者的组织学分级均与患者生存期之间存在不同程度的相关。但年龄、性别、肝脏转移灶的最大直径以及是否进行肝脏介入治疗与患者的生存期之间未见相关性。结论无腹腔淋巴结广泛转移的胃癌肝转移后实施肝切除术可以延长患者的生存期。     

静脉注射大剂量人体丙种球蛋白对儿童重症病毒性脑炎预后的影响

①目的　探讨静脉注射大剂量人体丙种球蛋白 (IVIG)对儿童重症病毒性脑炎 (SVE)预后的影响。②方法　将 5 6例SVE病儿随机分为常规组 (n =2 2 ,给予抗病毒、降颅压、止惊、冬眠疗法、加压氧和糖皮质激素等常规治疗 )和IVIG组 (n =34,在常规治疗基础上尽量在 7d内给予IVIG ,剂量为每天 4 0 0～ 6 0 0mg/kg体质量 ,共2～ 3d) ,比较两组病儿治疗后的近期和远期预后 ,测定两组治疗前后血浆白细胞介素 6 (IL 6 )、肿瘤坏死因子 α(TNF α)水平并与对照组进行比较。③结果　与常规组比较 ,IVIG组治疗过程中呼吸衰竭、消化道出血、院内感染的发生率和病死率明显降低 (χ2 =6 .5 10～ 13.86 0 ,P <0 .0 5 ,0 .0 1) ;病后遗留脑性瘫痪者明显减少 (χ2 =4 .0 2 7,P <0 .0 5 ) ;病后 3,6 ,12个月IVIG组除瘫痪外 ,癫痫、脑影像学损害、脑电图和脑干听觉诱发电位异常者均明显减少 (χ2 =6 .4 5 1～ 4 5 .5 81,P <0 .0 5 ,0 .0 1) ;病后 6 ,12个月IVIG组的言语智商和总智商较常规组明显高 (t =2 .0 81～ 3.4 13,P <0 .0 5 ,0 .0 1)。IVIG组在病后 3,6个月时血浆IL 6 (15 .1,7.5ng/L)和TNF α(2 0 .4 ,11.8ng/L)水平较对照组 (4.2 ,8.5ng/L)明显升高 (z =- 3.337～ - 3.899,P <0 .0 1) ,但病后 12个月时血浆IL 6和TNF      

The prognostic value of facial electroneurography in Bell's palsy

Twenty six patients with Bell's palsy were studied at presentation using electroneurography. Ninety-four per cent of those who recovered completely could have been predicted by ENoG within 10 days of onset. Of the 18 patients who recovered completely, 13 had a total palsy at presentation.     

血浆纤维连接蛋白含量对肺性脑病预后判断的临床价值

采用火箭电泳法对６４例（８０例次）肺性病患者进行血浆纤维连接蛋白（Ｆｎ）测定。合并肺性脑病１９例，并与１０６例健康人及１０４例其他呼吸疾患进行对比．结果表明：正常组、肺性病缓解组、急性发作组、肺性脑病组血浆Ｆｎ水平分别为３４．２７±６．３６ｍｇ／ｄｌ，２９．６１±４．２５ｍｓ／ｄｌ，１５．２１±５．２０ｍｇ／ｄｌ，１１．８２±５．６７ｍｇ／ｄｌ．肺性脑病患者血浆Ｆｎ显著降低，并随病情恶化而进一步下降。同时，其含量变化与ｐＨ值和ＰａＯ２呈正相关，与ＰａＣＯ２，呈负相关。因此动态观察肺性脑病患者血浆Ｆｎ含量可作为判断顶后一项较为可靠的指标。     

The relationship of proliferating cell density at the invasive tumour front with prognostic and risk factors in human oral squamous cell carcinoma

BACKGROUND: We hypothesise that the density of proliferating cells at the invasive tumour front (ITF) has a positive relationship with prognostic and risk factors in human oral squamous cell carcinoma (SCC). METHODS: Tissues from 47 human oral SCC specimens were collected and stained with a monoclonal antibody directed against the Ki-67 antigen using a horseradish peroxidase based two-step immunostaining method. Counting was performed on two parallel sections at the ITF using an image analyser. The Ki-67 labelling index (LI) was determined by measuring the number of nuclei/mm(2) of epithelium. RESULTS: Our results show that the density of proliferating cells is related to clinical staging, with advanced stage of disease having a significantly higher Ki-67 LI compared with early stage of disease (2111 +/- 905 vs. 1908 +/- 913; P = 0.03). Importantly, this study shows that tumours that have metastasised have a significantly higher Ki-67 LI than tumours where distant metastasis was not detected (3257 +/- 650 vs. 1966 +/- 881; P < 0.0001). CONCLUSIONS: Cell proliferation, as measured by the Ki-67 LI at the ITF, has a positive relationship with clinical staging, tumour thickness, smoking status of the patient and alcohol consumption. Further, we suggest that a multicenter study with a large cohort of patients is indicated to fully elucidate whether cell proliferation at the ITF is directly related to patient survival.