目的高危型人乳头瘤病毒(high-risk human papillomavirus,HPV)感染是宫颈癌的主要致病原因,现已发现HPV感染可诱发人类的许多肿瘤和疣。文中旨在探讨南京地区肛管及肛门区尖锐湿疣(condyloma acuminata,CA)患者中HPV基因类型的感染情...目的高危型人乳头瘤病毒(high-risk human papillomavirus,HPV)感染是宫颈癌的主要致病原因,现已发现HPV感染可诱发人类的许多肿瘤和疣。文中旨在探讨南京地区肛管及肛门区尖锐湿疣(condyloma acuminata,CA)患者中HPV基因类型的感染情况及其临床意义。方法从86份肛管及肛门区CA石蜡组织标本中提取23种HPVDNA,采用基因扩增芯片技术对其组织进行23种HPV基因类型的检测,并对其患者进行临床病理资料分析。结果 86份肛管及肛门区CA患者组织标本中检出HPV阳性66例,感染率为76.74%(66/86),其中单一型的阳性检出率为56.98%(49/86);单一型的感染中HPV11型为26例,其阳性检出率为30.23%(26/86),是最主要的感染类型;其次HPV6型为23例,阳性检出率为26.74%(23/86);混合型HPV感染17例,阳性检出率为19.77%(17/86);其中HPV6+11型8例,占混合型感染的47.06%(8/17),是混合型感染的主要类型;其次是5例4种类型的混合感染,占混合型感染的29.41%(5/17)。结论 HPV11型、6型、6+11型、4种类型的混合感染是肛管及肛门区CA的主要致病类型,基因扩增芯片检测技术是一种比较适合临床进行HPV分型检测的、敏感性高和特异性好的诊断方法,尤其适合开展某种病变中HPV感染的分子流行病学的研究。展开更多
PURPOSE: This study was designed to assess the long- term results following radiochemotherapy in patients with anal squamous- cell carcinoma and to evaluate the impact of tumor location on response, survival, and colo...PURPOSE: This study was designed to assess the long- term results following radiochemotherapy in patients with anal squamous- cell carcinoma and to evaluate the impact of tumor location on response, survival, and colostomy- free survival. PATIENTS AND METHODS: Between 1985 and 2001, a total of 101 patients with anal carcinoma were registered for curative treatment, of whom 77 had involvement of the anal canal alone, 10 cases had extension into the perianal skin, and 14 patients had pure anal margin tumors. Small tumors of the anal margin were not included since they were treated by surgical excision only. Among the 101 patients were 74 women and 27 men with a median age of 62 (range, 26- 84) years. T categories (Interna- tional Union against Cancer) were T1 (15), T2 (36), T3 (34), and T4 (16). Seventy- one patients had no evidence of nodal disease, whereas 30 presented with involved regional nodes. Radiation treatment was directed to the primary tumor region and to the inguinal, perirectal, and internal iliac nodes using a three- field to four- field box technique with 10MV photons up to a total dose of 5040 cGy. Lesions greater than 5 cm received an additional boost by interstitial or external radiation depending on circumferential extension of the residual tumor. All patients were scheduled for simultaneous chemotherapy with two cycles of 5- fluorouracil at a dose of 1000 mg/m2/day as 120 hours of continuous intravenous infusion on Days 1 to 5 and 29 to 33 and mitomycin C at 10 mg/m2/day on Days 1 and 29. Median follow- up time was was 7.5 (range, 1- 16) years. RESULTS: Overall survival and colostomy- free survival rates for patients with anal canal cancer were 75 percent and 87 percent at five years, respectively. Patients with anal margin cancer had a less favorable outcome with five- year- overall and colostomy- free survival rates of 54 percent and 69 percent, respectively. After correction for imbalance between anal canal and anal margin tumors, i.e., exclusion of T1 tumors of the anal canal, difference in overall survival remained significant (73 percent vs. 54 percent, P = 0.01). Following multivariate analysis, tumor location (anal canal vs. anal margin, P = 0.02), age (P = 0.003), and dose intensity of chemotherapy (≤ 75 percent vs. > 75 percent, P = 0.03) remainedindependent significant factors for overall survival. Initial tumor response at six weeks (P = 0.03) was predictive for colostomy- free survival. CONCLUSIONS: With colostomy- free survival rates around 85 percent, long- term treatment results for anal canal carcinoma have reached a satisfactory level. However, patients with larger lesions of the perianal skin are at high risk for locoregional recurrence and possible treatment intensification in this subgroup seems desirable.展开更多
外阴上皮非瘤样病变（nonneoplastic epithelial disorders of vulva,NNEDV）临床上也称外阴白色病变,是一组以女性外阴肛门生殖区域皮肤顽固性瘙痒及烧灼感、排尿困难为主要临床症状,外阴病损区皮肤、粘膜组织发生色素改变、皮肤出现...外阴上皮非瘤样病变（nonneoplastic epithelial disorders of vulva,NNEDV）临床上也称外阴白色病变,是一组以女性外阴肛门生殖区域皮肤顽固性瘙痒及烧灼感、排尿困难为主要临床症状,外阴病损区皮肤、粘膜组织发生色素改变、皮肤出现粗糙、萎缩、皲裂为主要体征的常见慢性疾病。这类疾病于不同年代对该病临床、病理认识不同而几经易名,过去这类病变归类于外阴营养不良。展开更多
Introduction. Leucinosis (maple syrup urine disease) is a metabolic disorder c ausedbyanenzymatic deficiency involved in the degradative pathways of the three branched-chain amino acids. We report an observation of ac...Introduction. Leucinosis (maple syrup urine disease) is a metabolic disorder c ausedbyanenzymatic deficiency involved in the degradative pathways of the three branched-chain amino acids. We report an observation of acrodermatitis enteropa thica-like syndrome induced by essential amino acid deficiency in a child with leucinosis. Case report. A child with leucinosis was referred to our hospital fo r exfoliative dermatitis of the perioral and anogenital regions associated with diarrhea and pancytopenia. The diagnosis of iatrogenic acrodermatitis enteropath ica-like syndrome was confirmed after screening showing isoleucine deficiency. Rapid response was observed after adequate isoleucine supplementation. Discussio n. The acrodermatitis enteropathica-like eruption in our patient was due to an iatrogenic amino acid nutritional imbalance. Our observation underlines the risk of using a branched-chain amino acid-free formula without adequate supplement ation of deficient amino acids. In addition, dietary insufficiency of isoleucine , associated with the treatment of organic aciduria should be added to the cause s of acrodermatitis enteropathicalike syndrome.展开更多
文摘PURPOSE: This study was designed to assess the long- term results following radiochemotherapy in patients with anal squamous- cell carcinoma and to evaluate the impact of tumor location on response, survival, and colostomy- free survival. PATIENTS AND METHODS: Between 1985 and 2001, a total of 101 patients with anal carcinoma were registered for curative treatment, of whom 77 had involvement of the anal canal alone, 10 cases had extension into the perianal skin, and 14 patients had pure anal margin tumors. Small tumors of the anal margin were not included since they were treated by surgical excision only. Among the 101 patients were 74 women and 27 men with a median age of 62 (range, 26- 84) years. T categories (Interna- tional Union against Cancer) were T1 (15), T2 (36), T3 (34), and T4 (16). Seventy- one patients had no evidence of nodal disease, whereas 30 presented with involved regional nodes. Radiation treatment was directed to the primary tumor region and to the inguinal, perirectal, and internal iliac nodes using a three- field to four- field box technique with 10MV photons up to a total dose of 5040 cGy. Lesions greater than 5 cm received an additional boost by interstitial or external radiation depending on circumferential extension of the residual tumor. All patients were scheduled for simultaneous chemotherapy with two cycles of 5- fluorouracil at a dose of 1000 mg/m2/day as 120 hours of continuous intravenous infusion on Days 1 to 5 and 29 to 33 and mitomycin C at 10 mg/m2/day on Days 1 and 29. Median follow- up time was was 7.5 (range, 1- 16) years. RESULTS: Overall survival and colostomy- free survival rates for patients with anal canal cancer were 75 percent and 87 percent at five years, respectively. Patients with anal margin cancer had a less favorable outcome with five- year- overall and colostomy- free survival rates of 54 percent and 69 percent, respectively. After correction for imbalance between anal canal and anal margin tumors, i.e., exclusion of T1 tumors of the anal canal, difference in overall survival remained significant (73 percent vs. 54 percent, P = 0.01). Following multivariate analysis, tumor location (anal canal vs. anal margin, P = 0.02), age (P = 0.003), and dose intensity of chemotherapy (≤ 75 percent vs. > 75 percent, P = 0.03) remainedindependent significant factors for overall survival. Initial tumor response at six weeks (P = 0.03) was predictive for colostomy- free survival. CONCLUSIONS: With colostomy- free survival rates around 85 percent, long- term treatment results for anal canal carcinoma have reached a satisfactory level. However, patients with larger lesions of the perianal skin are at high risk for locoregional recurrence and possible treatment intensification in this subgroup seems desirable.
文摘外阴上皮非瘤样病变（nonneoplastic epithelial disorders of vulva,NNEDV）临床上也称外阴白色病变,是一组以女性外阴肛门生殖区域皮肤顽固性瘙痒及烧灼感、排尿困难为主要临床症状,外阴病损区皮肤、粘膜组织发生色素改变、皮肤出现粗糙、萎缩、皲裂为主要体征的常见慢性疾病。这类疾病于不同年代对该病临床、病理认识不同而几经易名,过去这类病变归类于外阴营养不良。
文摘Introduction. Leucinosis (maple syrup urine disease) is a metabolic disorder c ausedbyanenzymatic deficiency involved in the degradative pathways of the three branched-chain amino acids. We report an observation of acrodermatitis enteropa thica-like syndrome induced by essential amino acid deficiency in a child with leucinosis. Case report. A child with leucinosis was referred to our hospital fo r exfoliative dermatitis of the perioral and anogenital regions associated with diarrhea and pancytopenia. The diagnosis of iatrogenic acrodermatitis enteropath ica-like syndrome was confirmed after screening showing isoleucine deficiency. Rapid response was observed after adequate isoleucine supplementation. Discussio n. The acrodermatitis enteropathica-like eruption in our patient was due to an iatrogenic amino acid nutritional imbalance. Our observation underlines the risk of using a branched-chain amino acid-free formula without adequate supplement ation of deficient amino acids. In addition, dietary insufficiency of isoleucine , associated with the treatment of organic aciduria should be added to the cause s of acrodermatitis enteropathicalike syndrome.
