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THE DIAGNOSIS AND TREATMENT OF LIVER CELL ADENOMA IN 5 CASES

目的 探讨肝细胞腺瘤的诊断与外科治疗方法。方法 对5例肝细胞腺瘤患者进行回顾性分析。结果 术前行B超检查4例，行CT检查2例及行MRI检查2例均未确诊。术前4例成人均误诊为原发性肝癌； 1例幼儿误诊为肝母细胞瘤。全部病例均做了肝叶或联合肝段切除术。结论 成人肝细胞腺瘤须与原发性肝癌相鉴别； 幼儿肝细胞腺瘤须与肝母细胞瘤相鉴别。肝细胞腺瘤误诊原因与其发病率低，缺乏典型的临床表现、生化检查指标和影像学特征有关。肝叶或联合肝段切除是肝细胞腺瘤的主要外科治疗方法。

Relationship Between βCatenin，Adenomatous Polyposis Coli Genes and Tumors

Objective To discuss the molecular structures and functions of βCatenin and APC (Adenomatous polyposis coli) genes, as well as the roles they played during the carcinogenesis and progression of tumors. MethodsAdvances in molecular biology and oncology of βCatenin and APC genes in recent years has been reviewed. ResultsHigh expression of βCatenin and APC genes was an early event during the carcinogenesis due to the abnormal regulation of βCatenin and APC genes. But on the contrary, the low expression of these two genes was probably associated with the progression of tumors. Moreover, βCatenin and APC genes could also regulate the expression of p53,cmyc genes and cyclin D1. Conclusion βCatenin and APC genes may play a key role during the carcinogenesis and progression of tumors and modulate other oncogen/suppressor gene and factors.

胸腺瘤合并重症肌无力患者的手术及围术期处理

目的 为提高胸腺瘤合并重症肌无力（MG）患者手术的安全性和治愈率，总结其临床经验。方法 1991年7月至2005年8月收治胸腺瘤合并MG23例，术前均给予肾上腺糖皮质激素和抗胆碱酯酶药物治疗，病情稳定后行胸腺扩大切除术，对发生MG危象患者予以气管切开或气管内插管，必要时使用呼吸机辅助呼吸。结果 全组无手术死亡，术后2例发生MG危象，经处理后痊愈。随访20例，失访3例，随访时间3个月～10年，缓解3例，明显改善11例，改善5例，无变化1例。其中1例胸腺瘤部分切除患者术后4个月死于肿瘤复发。结论 胸腺瘤合并MG患者除临床证实肿瘤无法切除或已胸外转移者外，其余均应手术治疗，完全切除胸腺瘤并清除前纵隔脂肪组织；正确的围术期处理是降低手术并发症及死亡率的关键。

The Preioperative Management of Metabolic Disturbance of Water and Natrium for Patients with Giant Pituitary Adenomas

摘要:目的:总结巨大垂体腺瘤水钠代谢紊乱的围手术期处理经验。方法:对71例巨大垂体腺瘤患者术前及术后1周内每日检测血、尿电解质水平,以及血、尿渗透压,判断失钠及失水类型。总结不同瘤体大小与手术入路和水钠紊乱发生率、程度、时间之间的关系。结果:71例巨大垂体腺瘤患者中,出现水钠代谢紊乱52例,发生率73.2%。肿瘤大小与水钠紊乱发生率、严重程度、发生时间成正比,而手术入路选择与水钠代谢紊乱发生无明显相关。结论:巨大垂体腺瘤患者术后水钠代谢紊乱的发生与瘤体大小成正相关,其出现时间和表现形式复杂。对水钠代谢紊乱严重患者可适当予以预防性治疗,以减少临床症状和不良后果。Abstract: Objective: To summarize the preioperative management experience of metabolic disturbance of water and natrium for patients with giant pituitary adenomas. Methods: The electrolyte and osmotic pressure of blood and urine in patients with giant pituitary adenomas were detected within preoperative and postoperative one week and the type of the metabolic disturbance of water and natrium were determined. The correlation of the different tumor size and surgical approach with the incidence rate, extent and time of the metabolic disturbance was summarized. Results: There were 52 cases with different extent metabolic disturbance of water and natrium in 71 cases of giant pituitary adenomas(73.2%). There were a positive correlation of tumor size with the incidence rate, extent and time of the metabolic disturbance, and a negative correlation of surgical approach with that of the metabolic disturbance. Conclusion: The metabolic disturbance of water and natrium in giant pituitary adenomas was positive correlation with the tumor size, which. is various in emergence time and pattern of manifestation. To reduce the clinical symptoms and adverse consequences, prophylactic treatment may be used in patients with serious metabolic disorder of water and natrium.

Expression and Clinical Significance of Phosphatase and Tensin Homologue Deleted on Chromosome Ten，Epidermal Growth Factor Receptor and Ki67 in Human Thymic Tumors

Abstract： Objective To investigate the expression and correlation of phosphatase and tensin homologue deleted on chromosome ten(PTEN)， epidermal growth factor receptor(EGFR) and Ki-67 in human thymic tumors, and their possible role in tumor genesis， infiltration and metastasis. Methods The expression of PTEN， EGFR and Ki-67 were detected by using SP immunohistochemical technique in 45 cases of thymic tumors and 5 cases of normal thymic tissues. Results In 5 cases of normal thymic tissues, the expression of PTEN was bly positive, whereas EGFR and Ki -67 were weakly positive or negative. In 45 cases of thymic tumors, the positive ratio of PTEN were significantly reduced from benign thymoma， invasive thymoma to thymic carcinoma (χ2=7.808, P=0.020), but the positive ratio of EGFR and Ki-67 were gradually increased(χ2=8.032, 0.018，7.006；P=0.030). The positive ratio of PTEN， EGFR and Ki-67 protein were significantly related to Levine classification, Masaoka staging and lymph node metastasis (Plt;0.05). PTEN positive cases were negatively correlated with EGFR and Ki-67(r=－0.632，－0.653；Plt;0.01), EGFR positive cases were positively correlated with Ki-67 in thymic tumors(r=0.807,Plt;0.01). Conclusions Reduced or absent PTEN and increased EGFR and Ki-67 expression might play an important role in the genesis， invasiveness and metastasis of thymic tumors. The expression of PTEN is bly associated with the expression of abnormal EGFR and Ki-67. Detection of the three protein expressions simultaneously might be more helpful in making an early diagnosis of the tumors jndgement of theirs malignant degree，invasiveness and metastasis capacity, as well as the prognosis.

眼底检查在家族性多发性息肉病随访观察中的价值

An Initial Study of Tumor-vessel Signs in Malignant Change of Tubulovillous Adenoma on 64-slice Spiral CT

ObjectiveTo investigate the correlation between tumor-vessel signs on 64-slice spiral CT (MSCT) and malignant change of tubulovillous adenoma in the colon and rectum. MethodsA retrospective study of the image and the clinical data of 16 patients with tubulovillous adenoma or malignant change proved by pathologies from February 2010 to October 2012 was conducted. The tumor-vessel signs were analyzed by multiplanar reformation (MPR) and maximum intensity projection (MIP) on picture archiving and communication systems workstation. ResultsAmong the 16 cases of tubulovillous adenoma or malignant change, 2 cases of tumor diameter≤2 cm had no tumor-vessel sign; and in the 14 cases of tumor diameter >2 cm, 13 were observed to bear tumor-vessel signs. The size of the tumor and tumor-vessel signs showed a certain correlation (r=0.618, P=0.002). And the manifestation of tumor-vessel signs had obvious differences between benign and malignant tumor. For the adenoma group, it showed venous blood vessel involvement, and downy and natural contour; for the adenocarcinoma group, it showed arterial blood vessel involvement, blood vessels with uneven thickness, visible expansion and irregular defect manifestations. No obvious difference was detected among tumor-vessel signs of adenocarcinoma with different malignant degree. ConclusionMSCT combined with image reconstruction techniques (such as MPR and MIP) can clearly demonstrate tumor blood supply, and tumor-vessel in the arterial phase may suggest a high risk of malignant change of tubulovillous adenoma in the colon and rectum.

96例重症肌无力患者的外科治疗

目的 总结重症肌无力（MG）患者的外科治疗和围术期处理经验，以提高手术疗效。 方法 2002年1月至2007年6月，对96例MG患者行胸腺切除加前纵隔脂肪组织清扫术，根据临床相对记分、服药量改变及生活能力于术后3个月评估临床疗效。 结果 无围术期死亡。术后发生MG危象8例（8.3% ），其中术前未服用糖皮质激素6例（18.75%），服用糖皮质激素2例（3.13%），经相应的治疗治愈。术后发生其他并发症9例（9.4%），其中肺部感染7例，切口感染2例，均经相应的治疗治愈。随访96例，随访时间3~18个月，其中32例临床痊愈，30例基本痊愈，15例显效，12例好转，7例无效。 结论 MG患者经内科治疗效果不佳或无效时，均应考虑手术治疗，无论是否有胸腺增生，特别是对合并有胸腺瘤者，应限期手术。若决定行手术治疗，术前除继续服用抗胆碱酯酶药物外，口服糖皮质激素15d左右可增加手术安全性，提高手术疗效。

Analysis of the central visual fields of pituitary adenoma

Objective To analyze the central visual fields and the ocular fundus changes of both eyes of patients with pituitary adenoma.Methods A total of 70 cases of pituitary adenoma received the examination of static central visual fields of all-liminal values by Humphrey instruments 750 cycloscope and the fundus exams by Topcon TRC-50X fundus photography before operations. Results There were 64.3% patients with decreased visual acuities, 80.7% with the defect of visual field, and 46 .4% with fundus changes. The decrease of the visual acuity was the first diagnostic symptom in 45.7% patients, among whom 28.6% were misdiagnosed as ocular diseases.Conclusions The misdiagnosed cause is that the first diagnostic symptom is the decrease of visual acuity without defect of visual field accompanied by ocular diseases. To avoid the misdiagnosis and the omitter of pituitary adenoma, general examination of visual field should be carried out in the patients with decreased visual acuity and optic atrophy with unknown reason in the clinical diagnosis of ophthalmology. (Chin J Ocul Fundus Dis，2003，19：18-19)

Congenital Cystic Adenomatoid Malformation of Lung: A Case Report and Review of the Literature

目的　全面介绍先天性囊性腺瘤样畸形(CCAM)其可能的病因，临床、病理特点及诊断手段，循证探讨针对CCAM的治疗方法及预后。 方法　对我院2011年11月收治的1例罕见的CCAM患者的临床资料进行分析，并对相关文献进行复习。 结果　患者数次误诊后最终诊断为CCAM，予手术治疗后痊愈，随访1年无复发。 结论　 CCAM是一种少见的、非遗传性的、错构瘤样的肺发育异常，为一种良性的肺部畸形，其特点是局部肺终末呼吸性细支气管过度生长。CCAM多通过产前影像学检查、活组织检查或术后病检诊断。手术为治愈该病的最根本、最重要措施。