前列腺癌是老年男性泌尿生殖系统常见恶性肿瘤.治疗方法包括手术、放射治疗、内分泌治疗和化疗.对于局限性前列腺癌手术治疗和放射治疗可以达到根治的目的.放射治疗包括外照射治疗和近距离放射治疗.

125I粒子植入术以其手术成功率高、并发症少、患者耐受性好等优势在老年前列腺癌患者中广泛应用[1].此外,为了提高放射性粒子植入治疗效果,125I放射性粒子植入的近距离内放射治疗联合内分泌治疗已开始应用于局限性前列腺癌的治疗. 因此,我们通过回顾性分析116例前列腺癌患者临床资料, 对比分析内分泌治疗和 125I粒子植入联合内分泌治疗两种方案的临床治疗效果和生化无进展生存率,进而为老年前列腺癌患者的治疗提供临床研究证据.

目的 评价舒尼替尼一线治疗转移性肾癌的疗效、安全性,并探讨其对不同转移灶的疗效.方法 2008年12月至2011年7月经病理确诊为转移性肾透明细胞癌的38例患者接受舒尼替尼治疗,男25例,女13例,中位年龄57(32～74)岁.曾行原发肿瘤姑息性切除术35例,行彩超引导下肿瘤穿刺活检术3例,组织学类型均为肾透明细胞癌.治疗方案为舒尼替尼50 mg/d,4/2方案34例,37.5 mg/d,持续口服方案4例.结果 中位随访时间13(3～34)月.36例患者治疗2周期以上,可进行疗效评估.根据标准进行疗效评价显示部分缓解(PR)6例(16.7％),疾病稳定(SD)28例(77.8％),疾病进展(PD)2例(5.6％),其中死亡1例.全组客观反应率16.7％(6/36),疾病控制率94.4％(34/36).主要不良反应包括乏力11例(30.6％)、脱发3例(8.3％)、血小板减少21例(58.3％)、甲状腺功能异常26例(72.2％)、白细胞减少20例(55.6％)、高血压16例(44.4％)、手足反应10例(27.8％)、腹泻4例(11.1％)等.大多数不良反应为1～2级,3级以上不良反应包括血小板降低2例(5.6％)和水肿1例(2.8％)等.13例(36.1％)患者在治疗过程中减量或停药,停药时间均小于2周.通过对症支持,减量或停药,不良反应可控制并耐受.缓解病例多为局部复发及肺转移病灶,进展病例为骨、肝、脑转移病灶.结论 舒尼替尼一线治疗晚期转移性肾透明细胞癌可取得较高的疾病控制率,不良反应可控、可逆,并且其对不同器官组织转移灶的疗效可能存在一定的差异.

Objective To investigate the expression of 14-3-3ε protein in the bladder urothelial carcinoma (BUC) and to explore its association with the clinicopathologic features.Methods The bladder urothelial carcinoma samples were divided into three groups:normal control group of 10 cases,low-grade malignant BUC group of 25cases (includes 5 cases of papilloma,10 cases of PUNLMP and 10 cases of low grade non-invasive papillary urothelial carcinoma),high-grade malignant BUC group of 21 cases (includes 11 cases of high-grade non invasive papillary urothelial carcinoma and 10cases of infiltrating carcinoma).The expression and location of 14-3-3ε in three groups were detected by immunohistochemical EnVision and the relationship with clinicopathologic parameters was analyzed.Results 14-3-3ε expression was observed in the cytoplasm of the cell.The expression of 14-3-3ε in normal control group was 90 ％ (9/10),low-grade malignant BUC group was 72.0 ％ (18/25),high grade malignant BUC group was 14.3 ％ (3/21).It correlated with histological grading but had not showed correlation with other clinicopathologic parameters.There was significant difference in 14-3-3ε expression between the high grade malignant BUC group and the low-grade malignant BUC group,the high grade malignant BUC group and norml control group (all P ＜ 0.05).Conclusions 14-3-3ε plays an important role in carcinogenesis of BUC.It may be a biomarker for early diagnosis and classification of BUC and shows promise for clinic application.

<正>我院于2000年至2010年收治2例女性尿道平滑肌瘤患者。现就其临床特点及治疗方法报告如下。病例1,女,55岁,发现尿道外口肿物半年入院,未诉明显不适。查体见尿道外口偏左与阴道前壁之间,直径近4cm实性肿物,质韧、光滑,表面无溃破及分泌物。彩超示尿道外口大小约3.50cm×2.99cm低回声实性肿物,边界清,彩色多普勒超声示内部可见丰富血流信号。在腰麻下行经尿道外口肿物切除术,术中见肿物包膜完整,基底与尿道肌层粘连,剖面呈粉白色。尿道外口黏膜外翻与皮肤缝合。病理诊

目的 探讨肾细胞癌伴肉瘤样分化疾病的临床表现、病理特点、诊治方法.方法 分析1例巨大肾细胞癌伴肉瘤样分化的临床及病理特点,行右肾癌根治术并文献复习.结果 病理检查:40 cm×40 cm×30 cm,肿瘤质量7 kg.镜下肿瘤大部分由嗜酸性胞质的肾癌细胞组成,Ⅱ～Ⅲ级,部分区域细胞呈梭形细胞形态,排列密集,肿瘤伴坏死.免疫组织化学染色S-100-、Syn-、CGA(±)、AE1/AE3部分(+)、Vim+、CD+10、EMA部分(+)、SMA-、CD117,部分(+)、CD-34、Ki-67 30%(+).病理诊断:肾细胞癌伴肉瘤样分化.随访未见复发.结论 巨大肾细胞癌伴肉瘤样分化恶性程度高,预后不良,但与肉瘤样成分比例相关,确诊依赖病理及免疫组织化学检查.根治性切除、化疗、分子靶向治疗可行.

目的:研究来氟米特治疗原发性肾病综合征的疗效及其安全性。方法:将63例原发性肾病综合征患者分为来氟米特组(泼尼松+来氟米特)和单用泼尼松组,观察比较两组患者血尿生化指标变化。结果:肾病综合征患者治疗前后24h尿总蛋白和血清肌酐比较差异具有统计学意义;来氟米特组近期缓解率为85.33%,优于单用泼尼松组51.52%;两组患者血尿生化指标比较差异有统计学意义(P<0.05)。结论:来氟米特治疗肾病综合征有较好的近期疗效,同时具有副作用较小的特点。

OBJECTIVE:To evaluate the expression and clinical significance of urinary nuclear matrix protein (NMP22) and cytokeratin 18 (CK18) for transitional cell carcinoma of the bladder.METHODS:Urinary NMP22 and CK18 levels of 293 patients with transitional cell carcinoma of the bladder, 400 patients with non-transitional cell carcinoma of the bladder, and 105 bladder benign disease were analysed by enzyme-linked-immunosorbent assay (ELISA).RESULTS:The levels of urinary NMP22 and CK18 in the patients with transitional cell carcinoma of the bladder (M = 17.3 U/ml, M(CK18) = 484.2 U/L) were significantly higher than those in the non-transitional cell carcinoma of the bladder (M = 6.8 U/ml, M(CK18) = 156.0 U/L) and the benign disease group (M(NMP22) = 2.3 U/ml, M(CK18) = 66.6 U/L) (P < 0.001). The sensitivity and specificity of urinary NMP22 and CK18 were 79.2%, 88.6% and 78.2%, 82.9%, respectively, for transitional cell carcinoma of the bladder before any treatment. The joint sensitivity of the two markers was 91.7%. The NMP22 and CK18 levels were significantly lower in the recovered patients after surgical operation (P < 0.01), while in patients with recurrence or metastasis the levels of the markers were significantly higher (P < 0.01). There was a significant relationship between NMP22 and CK18, (r = 0.689, P < 0.01). The levels of urinary nmp22 and CK18 were significantly different among pathological grade G1, G2, G3, and stage Ta, T1, T2, T3 (P < 0.01).CONCLUSION:NMP22 and CK18 are useful tumor marker for diagnosis of transitional cell carcinoma of the bladder and for monitoring the state of illness. The joint use of the two markers can improve the sensitivity of cancer detection. NMP22 and CK18 may become a new class of tumor markers, and to be the basis for development of a new assay with an increased efficacy for the detection and treatment of bladder cancer.

Objective To investigate the protein expression of Omi/HtrA2 in NRK-52E apoptosis models and to observe the change of apoptosis after Omi/HtrA2 was inhibited.Methods The Omi/HtrA2-shRNA expression plas-mids 251(Pgenesil-1/Omi/HtrA1 shRNA1),252(Pgenesil-1/Omi/HtrA2 shRNA2),and negative plasmid HK(Pgene-sil-1/HK) were transfected into NRK-52E by liposome-mediated method.Protein expression of Omi/HtrA2 and cas-pase3 were quantified by Western blotting.Apoptosis in every group was analyzed by DNA ladder.Results Success-fully transfected cells were presented with green fluorescent NRK-52E.Western blotting showed higher expression of Omi/HtrA2 in the control group than in normal group.There was a significant reduction in Omi/HtrA2 expression in the groups transfected with 251 and 252 than in the controls(P0.05),while statistical difference between the groups transfected 251 and 252 was not found.The protein expression of caspase3 of the control group increased comparing to the normal(P0.05).The protein expression of caspase3 in the groups with inhibited Omi/HtrA2 was lower than that in the controls(P0.05).The distinctive ladder pattern was visible in the control group but appeared weaker in the 251 and 252 groups.Conclusion RNA interference technique was successfully used to inhibit the expression of Omi/HtrA2 in the hypoxia-reoxygenation model,which resulted in mitigation of apoptosis.

Objective:To investigate the surgical treatment of scrotum Paget disease.Methods:Twenty-three patients with scrotal skin lesions confirmed as scrotum Paget disease by biopsy were carried out the treatment of wide lesion excision on the basis of the anti-infection and the wound surfaces were covered with orthotopic and metastatic flap treatment.The patients with lymph node metastases confirmed by biopsy were performed by lymph node excision but the unresectable lymphatic metastatic cancer was carried out the treatment of radioactive particle implantation.Results: There were 9 cases in stage A1,6 cases in stage Af2,6 cases in stage B and 2 cases in stage C.The surgery was totally undertaken for 24 times but only 1 case was done a second time because of postoperative recurrence.Conclusions: The patients with scrotal skin lesions who couldn't recover for a long time should be diagnosed by biopsy as early as possible and the wide lesion excision might be the best means of curing the disease.And radioactive particle implantation might be an effective means of curing the unresectable lymphatic metastatic cancer.

放射性膀胱炎是盆腔恶性肿瘤放射治疗时,膀胱局部遭受放射性损伤而发生的放疗并发症.其病理、临床表现、诊断和治疗不同于其他膀胱疾病,认识其独特的疾病特点对于诊断、探索治疗和预防该病有重要意义.

Objective: To discuss the causes of secondary erythrocytosis and the perioperative treatment of the patients with renal carcinoma combined with secondary erythrocytosis.Methods: The perioperative treatment of three cases with renal carcinoma combined with secondary erythrocytosis and the literature review were summarized.The three patients were diagnosed as renal carcinoma combined with secondary erythrocytosis by B-mode ultrasonography and CT before operation.Blood routine examination showed hemoglobin was higher than normal.Results: The measures of active preoperative preparations and radical nephrectomy,postoperative fluid expansion and improving microcirculation were adopted until the patients were discharged with full recovery.Conclusions: The patients with renal carcinoma combined with secondary erythrocytosis are performed excision focus and given fluid resuscitation at the same time so as to maintain proper hematocrit.Postoperative symptomatic treatment can enable the patients to tide over the perioperative period safely.

尿道肿瘤在临床上很少见.据国外文献统计仅占全身肿瘤的1%以下,在泌尿生殖系肿瘤亦不占重要地位[1].其中尿道透明细胞癌(CCA)更为罕见.我院于2004年2月收治一例,现结合文献就其特征、诊断和处理方法报告如下.

目的:总结经尿道电切61例浅表性膀胱肿瘤的疗效及其适应证.方法:经尿道电切61例浅表性膀胱肿瘤,均随诊6个月～24个月,术后常规膀胱灌注治疗.结果:经尿道电切治疗浅表性膀胱肿瘤61例,复发2例,均为非原住复发,复发升级1例.结论:经尿道电切浅表性膀胱肿瘤TURBT术,创伤小,出血少,恢复快,适宜临床推广应用.