BACKGROUND: The application of biological response modifiers (BRMs) has become the fourth cancer treatment following surgery, chemotherapy and radiotherapy. Polysaccharide-peptide (PSP) is a biological response modifier substance playing a special role in cancer treatment, which has been used in the treatment of gastric cancer, lung cancer, esophagual can cer, etc. With good results. OBJECTIVE: To observe the effect of PSP on the immune function and quality of life (QOL) in patients receiving chemotherapy for gynecological malignancies. DESIGN: A comparative observation. SETTING: Department of Obstetrics and Gynecology, Shanghai Jiaotong University Affiliated First People's Hospital. PARTICIPANTS: Forty patients who had been operated on for gyneco logical malignancies were selected from the Department of Obstetrics and Gynecology, Shanghai Jiaotong University Affiliated First People's Hospital from June 1999 to December 2002, including 36 cases of ovarian cancer with an average age of 52 years and 4 cases of endometrial cancer with an average age of 54 years. Patients with ovarian or endometrial cancer suffered from no contraindication in chemotherapy postoperatively were enrolled, otherwise were excluded.METHODS: The 40 patients were divided into study group (n=20) and control group (n=20) by matching according to stage and age. In the study group, the patients were treated with PSP capsules in addition to chemotherapy, whereas those in the control group were treated with chemotherapy only. PAC (phenacetin, spirin, caffeine) and MFP (melphalan, 5-fluorouracil, medroxyprogesterone acetate) regimens were adopted for the ovarian cancers and endometrial cancer respectively. The experiment lasted for two months from the beginning of the second course of chemotherapy to the beginning of the fourth one.MAIN OUTCOME MEASURES: The indexes of blood immune function and QOL were observed before and after treatment.RESULTS: All the 40 patients were involved in the analysis of results. ①The average Karnofkky's scores before and after treatment were (84±9.6)and (90±8.6) in the study group (P ＜ 0.05), and (83±9.2), (80±12.8) in the control group (P ＞ 0.05). The average Karnofkky's score was 10 credits higher in the study group than in the control group (P ＜ 0.05). ② The CD4+,CD4+/CD8+ and natural killer cells after treatment in the study group were all obviously higher than those in the control group (28.14±4.10, 0.96±0.17,23.80±4.90; 23.12±3.97, 0.75±0.21, 5.32±3.90) (P ＜ 0.05, 0.01).CONCLUSION: PSP can improve the cellular immunity and QOL of patients with ovarian or endometrial cancers.

Objective To investigate the effects of morroniside on fibrinogen (Fib), prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) in focal cerebral ischemia/reperfusion in rats. Methods The animal model was induced with occlusion of middle cerebral artery (MCAO) with suture embolus, and morroniside was then administered intragastrically at the dose of 30, 90 and 270 mg/kg for 7 d. Acetyl salicylic acid was taken as positive control drug. The content of Fib, and PT, APTT and TT were measured withrelated kits. Results Compared with the sham-operated group, the concentration of Fib significantly increased (P<0.001) and PT, APTT and TT significantly shortened in the model group (P<0.001); however, compared with the model group, morroniside significantly decreased Fib content (P<0.01) and prolonged PT, APTT and TT (P<0.05). Conclusion Morroniside can antagonize the coagulation function in focal cerebral ischemia/reperfusion in rats.

Parkinson's disease is a common progressive neurodegenerative disorder among old people, characterized by progressive loss of dopamine-producing neurons in the substantia nigra pars compacta and accordingly low level of dopamine in the nigrostriatal pathway.Neuroinflammation and even systemic inflammation have been suggested to be involved in the demise of dopaminergic neurons. Anti-inflammatory treatment could protect brain from inflammatory injury and prevent the progressive course of Parkinson's disease, which suggests a potential new strategy for Parkinson's disease treatment.

Objective To evaluate the effectiveness of second cytoreductive surgery in the treatment of epithelial ovarian cancer.Methods From January 1989 to June 1994, second cytoreductive surgery was carried out on 33 patients with epithelial ovarian cancer who either underwent unsatisfactory primary debulking operation or had recurrence. According to FIGO staging (1987), there were 5 patients in stage Ⅰ, 2 in stage Ⅱ, 25 in stage Ⅲ, and 1 in stage IV. Pathological grading was G1 in 2 cases, G2 in 9, G3 in 19 and uncertain in 3. The 33 patients can be divided into 3 categories: Ⅰ, nine patients who had unsatisfactory primary debulking operation with macroscopic residual >2 cm, and 1-2 courses of postoperative chemotherapy; Ⅱ, 15 patients who had 6-8 courses of cisplatin-based postoperative chemotherapy and in whom recurrence was diagnosed after complete response for at least 3 months; and Ⅲ, 9 patients who had the same treatment as category Ⅱ and survived without cancer clinically for more than 6 months, and in whom recurrence was diagnosed during second-look laparotomy. All patients had been followed up for at least two years (27-168 months) dated from the primary debulking operation.Results Fifteen cases had no macroscopic residuals (group A), 5 had residuals <2 cm (group B), and 13 had residuals >2 cm (group C). The medium survival time and two-year survival rate in groups A, B and C were 59.09, 20.6 and 8.29 months, and 93.3%, 20% and 7.69% respectively (P<0.001, A vs C; P<0.05, A vs B and B vs C).Conclusions The results suggest that second cytoreductive surgery is of value, and the key to success is to eliminate any macroscopic residual focus, or at most, to leave only minimal residuals <2 cm. It is suggested that well-targeted multiple-route chemothe-rapy with sufficient courses before second cytoreductive surgery is important to achieving better results.

Objective To evaluate the values of bilateral inferior petrosal sinus sampling ( BIPSS),high dosage dexamethasone suppression test (HDDST) and pituitary image in the differential diagnosis of ACTH-dependent Cushing's syndrome. Methods Totally 87 patients with confirmed pathological diagnosis were recruited in the study.All received the procedure of BLPSS,HDDST,and pituitary MRI with dynamic enhancement.The diagnostic performances of three differential diagnosis methods in ACTH-dependent Cushing's syndrome were evaluated.Results Seventy-eight patients were diagnosed as cases of pituitary ACTH adenoma,and the remaining 9 were confirmed cases of ectopic ACTH syndrome due to the thymic carcinoid.The sensitivity and specificity of HDDST,pituitary MRI,and BIPSS for the diagnosis of ACTH-dependent Cushing's syndrome were 82.1％ and 100％,79.5％ and 44.4％,92.3％ and 100％,respectively.In Cushing's disease,the diagnostic accuracy was 83.9％ with HDDST,77.0％with pituitary MRI,and93.1％ with BIPSS.In those patients with Cushing's disease,the coincidence of lateralization was 83.9％ with BIPSS and 64.5％ with MRII.Conclusion BIPSS was better than the other two methods in differential diagnosis of ACTH-dependent Cushing's syndrome.Compared with the pituitary MRI,the concordant rate of BIPSS in lateralization of the tumor is higher,and it is more reliable.

Ectopic ACTH syndrome caused by adrenal pheochromocytoma is very rare.A case was herewith reported and the domestic and foreign literatures were reviewed.The correct diagnosis of the syndrome depends on clinical,biochemical,hormonal,radiographic,pathological investigations,as well as tumor immunohistochemistry for final comprehensive judgments.

[Summary] All patients with cholesterol side-chain cleavage enzyme ( P450scc) deficiency that have been reported presented with early adrenal failure. Here we described a 35-year-old male presented with infertility as the only initial presenting complaint. He had received two separate surgeries to remove bilateral testicular masses. We reevaluated the resected tumors and found testicular adrenal rest tumor ( TART) pathology in the resected tumor. We profiled steroid hormones and found significantly elevated ACTH. CT scan revealed bilateral adrenal hyperplasia. Mutation screening identified compound heterozygous mutations (R353W and P432L) in the P450scc encoding gene (CYP11A1). The patient was finally diagnosed as congenital adrenal hyperplasia.

Objective To investigate the short-term effects of chemotherapy-surgery-chemotherapy regimen on clinically inoperable advanced ovarian cancer. Methods Retrospective analysis was made on 16 cases of stage Ⅲ and 2 cases of stage Ⅳ epithelial ovarian cancer with fixed pelvic mass. Neoadjuvant chemotherapy with CP (cisplatin+cyclophosphamide) or CAP (CP+adriamycin) regimen was given by intraarterial, intraperitoneal, or systemic routes accordingly for an average of 2.8 courses. Sixteen of the 18 cases were assessed to be operable after preoperative chemotherapy. The uterus, adnexa, omentum, pelvic lymphnodes (14/18), and implants were included in the cytoreductive surgery. Pelvic masses were found to have almost disappeared in 9, and macroscopic residuals were found in 11 (residuals <2 cm in 2, and >2 cm in 5) of the 18 cases. Postoperative chemotherapy (CP, CAP, or CEP, E=VP16) was given for an average of 5.9 courses. Results Five out of 7 patients followed up for over 3 years have been surviving for 46, 44, 40, 38 and 36 months, respectively. Conclusion Chemotherapy-surgery-chemotherapy regimen has beneficial effects on clinically inoperable advanced ovarian carcinoma.

Objective To explore the expressions of hypoxia inducible factor ( HIF), vascular endothelial growth factor receptor 2 ( VEGFR 2), and microvessel density ( MVD) in adrenocortical adenoma ( ACA) and adrenocortical carcinoma ( ACC), in order to discuss their potential role in the development of adrenal tumours. Methods Fifty-five adrenal tumour specimens resected in the hospital with complete clinical data (including 30 ACA cases and 25 ACC cases) were examined by immunohistochemistry for the expressions of HIF-2α, HIF-1α, VEGFR 2, and MVD. Results VEGFR 2 and MVD up-regulated were found in the ACC group (P＜0.05). The expression of HIF-2α and HIF-1α correlated with VEGFR 2 (P＜0.05). The expressions of VEGFR 2 and MVD were related to some clinicopathological features ( P＜0. 05 ). Additionally, tumour size, expression of VEGFR 2 and MVD were independently associated with ACC (P＜0.05). Conclusions The high expression of HIF-2α, VEGFR 2, and MVD in adrenal tumours suggested their roles in tumour angiogenesis, which indicated that anti-angiogenesis therapies deserve intensive studies for malignant adrenocortical tumours.

Objective To investigate the methods and efficacy of treatment on severe adrenal Cushing′s syndrome. Methods The clinical data of 22 cases with severe adrenal Cushing′s syndrome ( severe group) , and 136 cases with mild or moderate adrenal Cushing′s syndrome ( non-severe group) were reviewed. The clinical features were analyzed by comparing the differences between these two groups when patients were admitted to hospital. We discussed the clinical managements of patients with severe adrenal Cushing′s syndrome by comparing the differences with non-severe group after preoperative preparation, and with themselves before and after preoperative preparation. The effects of surgery were evaluated by comparing the differences between pre-operation and post-operation on patients with severe adrenal Cushing′s syndrome. Results At admission, serum/urine cortisol, disease course, and blood pressure were significantly higher in the severe group than those in non-severe group ( P＜0.05 or P＜0.01) , serum potassium and ACTH level were decreased significantly in the severe group than those innon-severegroup[(3.01±0.75vs3.62±0.48)mmol/L,P＜0.01;(6.47±2.91vs8.21±3.22)pg/ml,P＜0.01] . However, no significant difference was observed in diastolic blood pressure, serum potassium, and fasting plasma glucose between these two groups after preoperative preparation (all P＞0.05). And then, we performed adrenalectomy. The symptoms of 22 cases with severe adrenal Cushing′s syndrome were obviously alleviated after 3 months. During follow-up, 5 cases of primary bilateral macronodular adrenal hyperplasia ( BMAH) and 1 case of primary pigmented nodular adrenocortical disease ( PPNAD ) were treated with contralateral adrenalectomy. Conclusion Sufficient preoperative preparation is essential for patients with severe adrenal Cushing′s syndrome because of its high level serum cortisol with severe complications. If preparation fails before surgery, cortisol-lowering medication or emergency unilateral adrenalectomy is necessary. Severe patients with BMAH and PPNAD were firstly performed unilateral adrenalectomy and followed-up closely, and then, contralateral adrenalectomy is needed when the recurrence of hypercortisolism recognized.