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Therapeutic effects of strontium-89 to prevent bone metastases of lung neoplasms：A clinical analysis of 30 cases

Objective To investigate the therapeutic effects of strontium-89 to prevent bone metastases of lung neoplasms.Methods Thirty patients with bone metastases of lung neoplasms received strontium-89 treatment (89SrCl2) at a dose of 148 MBq through intravenous injection.The analgesic effect was assessed by VAS method and doses or frequency of using analgesic drugs.Other efficacy parameters included changes in the number of osseous lesions and urinary levels of pyridinoline and deoxypyridinoline on the day 28 after therapy.Results The total pain relief rate was 73.3%(22/30)，among which 5(16.6%) cases with pain vanished，suggesting significant alleviation of the pain intensity by the treatment(Plt;0.001) on the day 28 after therapy.The number of lesions decreased in 16 cases with effective rate of 53.3%，showing the bone metastases significantly decreased after the therapy (Plt;0.001).The urinary levels of pyridinoline and deoxypyridinoline on the day 28 after therapy were (62.48±37.25)nmol/mmol Cr and (13.94±8.66)nmol/mmol Cr，respectively，which were decreased significantly compared to the levels before treatment which were (100.15±48.65)nmol/mmol Cr and (31.25±15.32)nmol/mmol Cr，respectively (both Plt;0.001).Conclusion Strontium-89 is effective to relieve pain and prevent bone lesions in patients with bone metastases of the lung neoplasms.

Value of Tumor Type M2 Pyruvate Kinase in Differential Diagnosis of Pleural Effusion

Objective To investigate the value of tumor type M2 pyruvate kinase ( M2-PK) in the differential diagnosis of pleural effusion. Methods A total of 146 patients with pleural effusion during January 2006 to December 2008 were recruited at the department of respiratory medicine of the Shantou Affiliated Hospital and the First Affiliated Hospital of Sun Yat-sen Medical College. Pleural effusion was malignant in 72 cases ( 52 cases with lung cancer and 20 cases with metastatic lung cancer) and benign in 74 cases ( 54 cases with infective pleural effusion and 20 with transudation effusion) . The patients were divided into a malignant pleural effusion group, an infective pleural effusion group, and a transudation group.Then the infective group was further divided into subgroups of tuberculosis pleural effusion group andparapneumonic effusion group. The concentration of tumor M2-PK in pleural fluid obtained during the first thoracocentesis was measured by enzyme-linked immunosorbent assay( ELISA) . Results The concentration of tumor M2-PK was significantly higher in the malignant pleural effusion group compared with the benignpleural effusion groups ( P lt; 0. 01) . Significant differences were also found in the concentration of tumor M2-PK between malignant pleural effusion caused by lung cancer and metastatic lung cancer( P lt; 0. 05) .When the cutoff value of tumor M2-PK was set at 18. 68 U/mL, the sensitivity, specificity, and accuracy for the diagnosis of malignant pleural effusion was 87. 6% , 86. 0% , and 87. 4%, respectively. Furthermore,the detection of tumor M2-PK in combination with CEA showed better diagnostic sensitivity( 96. 0% ) ,specificity ( 85. 0% ) , and accuracy ( 91. 1% ) . Conclusions The detection of tumor M2-PK in pleural effusion is of some clinical significance in the differential diagnosis of benign and malignant pleural effusion.The detection of tumor M2-PK in combination with CEA is a good diagnostic tool with high sensitivity andspecificity.

肺上皮样血管内皮细胞瘤一例并文献复习

目的 提高对肺上皮样血管内皮细胞瘤临床诊治的认识。方法 报告1 例肺上皮样血管内皮细胞瘤病例并进行相关文献复习。结果 患者为29 岁男性, 反复咳嗽10 个月。多次胸部CT均显示双肺多发性结节影, 临床诊断为肺癌、结节病、结核。最后经胸腔镜开胸肺活检病理诊断为肺上皮样血管内皮细胞瘤。结合本例并复习近20 年国内外文献报道的110 例肺上皮样血管内皮细胞瘤( 国外96 例, 国内14 例) 资料。结果显示本病女性多见, 发病年龄7 ～83 岁; 咳嗽为常见症状, 胸部CT 表现为结节影。确诊主要依靠手术病理检查。目前尚无有效的治疗措施。结论 肺上皮样血管内皮细胞瘤是一种罕见病, 临床无特异性, 极易误诊。

Videoassisted Thoracoscopic Surgery Bronchial Sleeve Lobectomy for Lung Cancer: Report of Preliminary Experience

Abstract: Objective To investigate the feasibility of videoassisted thoracoscopic surgery (VATS) ronchial sleeve lobectomy for lung cancer, and to describe this treatment method. Methods Between December 2010 and April 2011, three patients in our hospital underwent VATS bronchial sleeve lobectomy as treatment for right upper lobe nonsmall cell lung cancer. The patients were one female and two males, aged 61, 65, and 62 years. Surgical incisions were the same as for singledirection VATS right upper lobectomy. The right superior pulmonary vein was firstly transected, followed by the first branch of the pulmonary artery. Then, the lung fissure was transected and the mediastinal lymph nodes, including the subcarinal nodes, were also dissected to achieve sufficient exposure of the right main bronchus. The bronchus was transected via the utility incision, and the anastomosis was accomplished by continuous suture with 30 Prolene stitches. Another 0.5 cm port in the 7th intercostal space at the posterior axillary line was added in the third operation for handling of a pair of forceps to help hold the needle during anastomosis. A sealing test was performed to confirm that there was no leakage after completion of the anastomosis, and the stoma was covered with biological material. Bronchoscopy was performed to clear airway secretions and to confirm that there was no stenosis on postoperative day (POD) 1. Results The lobectomy and lymph node dissection was finished in 5158 minutes (averaging 54.7), and the time needed foranastomosis was 4055 minutes (averaging 45.7). Total blood loss was 55230 ml (averaging 155.0 ml). Number of dissected lymph nodes was 1821 (averaging 19.3). One patient was diagnosed with adenocarcinoma of the right upper lobe with metastatic hilar lymph node invasive to the right upper lobar bronchus. The other two patients were both diagnosed with centrally located squamous cell carcinoma of the right upper lobe, and all the patients achieved microscopically negative margins. There was no stenosis of the anastomosis stoma, and the postoperative course was uneventful. These patients were discharged on POD 810 (averaging 8.7 days), and they recovered well during the followup period, which lasted 2 to 6 months. [WTHZ]Conclusion [WTBZ]For experienced skillful thoracoscopic surgeons, VATS bronchial sleeve lobectomy is safe and feasible. Making the incisions of a singledirection VATS lobectomy with an additional miniport may be an ideal approach for this procedure.

肺鳞癌组织中脆性组氨酸三联体基因的表达

目的 探讨肺鳞癌组织中脆性组氨酸三联体(fragile histidine triad, FHIT)基因的表达及其与临床病理特征的关系。 方法 应用免疫组织化学treptavidin peroxidase，SP)法检测FHIT在42例肺鳞癌患者癌组织及13例癌旁组织中的表达，并研究FHIT蛋白阳性表达与肺癌临床病理特征、临床病理分期的关系。 结果 肺癌组织中FHIT蛋白阳性表达率显著低于癌旁组织(47.6% vs. 92.3%，Plt;0.05)。中/高分化患者FHIT蛋白阳性表达率显著高于低分化患者(54.2% vs. 38.9%，Plt;0.01)；有淋巴结转移患者FHIT蛋白阳性表达率显著低于无淋巴结转移患者［45.9%(17/37) vs. 60.0%(3/5)，Plt;0.05］；Ⅰ期+Ⅱ期患者FHIT蛋白阳性表达率显著高于Ⅲ期患者［55.0%(11/20) vs. 45.5%(10/22)，Plt;0.05］。 结论 FHIT基因在肺鳞癌的发生、发展中起重要作用，对其蛋白的检测有望作为判定肺鳞癌发生及转移能力的客观指标之一。

发生于肺腺癌患者的节段状视网膜动脉周围炎一例

The clinico-pathological analysis of choroidal metastatic carcinom aarising from lung carcinoma

Objective To observe the clinical and pathological characteristics of choroidal metastatic carcinoma from lung carcinoma.Methods The clinical and pathological data of 6 patients with choroidal metastatic carcinoma from lung carcinima were analysed retrospectively.Results All the 6 patients had severe visual impairment, including 3 with severe ophthalmalgia. Flat neoplasm were seen in the posterior pole of the eyes in all the 6 patients and retinal detachment were found in 5 patients. Fundus fluorescein angiography (FFA) examination had been performed on 1 patient and blocked fluorescence and hyperfluorescence were seen in the lesion with pinpoint fluorescein leakage loop around it. CT examination had been performed on 3 patients and the shadow of flat homogenous tumor was seen. MRI examination had been performed on 1 patient and high signal intensit ies on T1W and low signal intensities on T2W were found. In all the 6 patients with primary lung carcinoma, 5 were diagnosed with adenocarcinoma and 1 with cellule carcinoma through pathological examination, and 5 patients were diagnosed with choroidal metastatic carcinoma from adenocarcinoma and 1 with choroidal metastatic carcinoma from cellule carcinoma through pathological examination.Conclusion Rapid visual acuity decrease, severe ophthalmalgia, flat neoplasm in ocular fundus and secondary retinal detachment are the main clinical characteristics of the choroidal metastatic carcinoma from lung carcinoma. Most histopathologica l manifestations of the metastatic carcinoma like that of the primary focus, and adenocarninoma is the most common histoclassification. (Chin J Ocul Fundus Dis，2003，19：333-404)

肺癌脉络膜及皮下多发性转移一例

Clinicopathological Analysis of Primary Signet Ring Cell Adenocarcinoma of the Lung

目的　探讨原发性肺印戒细胞腺癌（PSRCACL）的临床病理学特点、诊断与鉴别诊断及其预后因素等。 方法　收集2000年1月－2012年6月间50例PSRCACL患者的临床资料，进行组织学及免疫组织化学检测观察，并进行随访和结合文献复习分析。 结果　PSRCACL的临床症状及影像学表现与非小细胞肺癌无明显差异，其诊断与鉴别诊断依据其特殊的细胞形态学及免疫组织化学检测。PSRCACL的发病率约占肺腺癌的1.20%，平均发病年龄为53.3岁，中位年龄为54.5岁，男女比例为1.17︰1。患者的中位生存时间约为56个月，1年生存率约为85.4%，3年生存率约为67.4%，5年生存率约为40.9%。患者的生存率与患者的性别、年龄无关（P＞0.05），与肿瘤的大小、是否伴有癌转移及TNM分期有关（P＜0.05）。 结论　PSRCACL是一种比较罕见的、好发于中青年人、恶性程度较高、易发生侵袭和转移、预后较差的恶性上皮性肿瘤，除手术治疗外，目前尚无标准化疗方案。

Multislice CT Findings on the Association of Peripheral Lung Carcinoma with Bronchia

目的：运用多层螺旋CT（MSCT）后处理技术显示周围性肺癌与支气管关系，分析其影像表现及诊断价值。方法：采用MSCT对77例周围性肺癌行层厚为0.5 mm的容积靶扫描，通过多平面或曲面重建（MPR或CMRP）以及表面遮盖（SSD）法显示支气管与周围肿块的关系,CT影像表现与手术、病理对照。结果：（1）全部3～7级支气管均全程、较完整显示。42例腺癌中与支气管有关系者为39例（92.9％），20例鳞癌中为15例（75.0％）。（2）肿瘤—支气管关系可分为4型：Ⅰ型，支气管被肿块截断；Ⅱ型，支气管进入肿块内后被截断；Ⅲ型，支气管在肿块内保持通畅；Ⅳ型，支气管紧贴肿块边缘走行，形态正常或受压移位。（3）发生率：Ⅰ型为48.1％（37/77），其中鳞癌略多于腺癌；Ⅱ型为13.0%（10/77），其中鳞癌略多于腺癌；Ⅲ型为16.9％（13/77），仅见腺癌；Ⅳ型为15.6％（12/77），腺癌略多于鳞癌。（4）与第四级支气管相关的肿块，鳞癌多于腺癌；与第六级支气管相关的肿块，腺癌多于鳞癌。结论：采用MSCT超薄层靶扫描后行MPR、CMPR和SSD重建，能准确显示肿块与支气管关系，并反映一定的病理改变关系，对良恶性鉴别或长期预后等相关性研究有着重要意义。