监测麻醉技术在内镜逆行胰胆管造影术中的应用

目的探讨监测麻醉技术在内镜逆行胰胆管造影术（ERCP）中的麻醉效果和安全性。方法将40例需行ERCP诊治的患者随机分为两组：常规组（N组）20例，行ERCP前口服2％利多卡因胶浆表面麻醉；监测麻醉组（M组）20例，在异丙酚＋瑞芬太尼麻醉下行ERCP，比较两组患者操作前后生命体征的变化，并以Ramsay镇静评分评价镇静效果。结果两组患者术中心率与血压与术前相比差异有统计学意义（P〈0．05），但M组维持在正常范围；两组脉搏血氧饱和度比较差异无统计学意义。M组Ramsay镇静评分优于N组。结论监测麻醉技术在ERCP操作中镇静效果满意，患者耐受性好，是安全可行的。     

Electron microscopy analysis of mineral fibers in human lung tissue.

In the present study, lung samples from 126 autopsied cases were examined to determine the content of mineral fibers using analytical transmission electron microscopy (ATEM). The cases were divided into four groups (22 lungs of persons exposed to ambient environmental pollution, 32 cases of mesothelioma, 38 cases of primary lung cancer, and 34 asbestosis cases, 13 of these with additional pleural plaques). Fibers were counted, measured, and mineralogically identified using a combination of X-ray microanalysis and electron diffraction of the non-oriented fiber. Concentration of fibrous particles (defined as particles above 1 micron in length with roughly parallel long sides and an aspect ratio of 5:1 and greater) was calculated as fibers 10(6)/g dry lung weight. The concentration of chrysotile was found to be similar throughout the groups except for two cases in the asbestosis group with comparably high numbers of chrysotile. However, a remarkable difference for amphiboles could be observed between the groups. Asbestos bodies were mostly found in the asbestosis group. There was a rather good correlation between numbers of amphibole fibers and asbestos bodies, with an average ratio of 10:1. For comparison purposes between occupationally exposed/non-exposed individuals, a transition was found in the concentration range of 3-10(7) asbestos fibers/g dried lung weight.     

CT in eosinophilic granuloma of the lung

We analyzed the chest CT findings in nine patients with biopsy-proven eosinophilic granuloma. Multiple cystic lesions with relatively thin walls seems characteristic of this disease. Small nodular lesions and increased density were observed in many cases. Pleural or subpleural lesions were found in all cases. In seven cases, the distribution of the lesions were predominantly in the upper or upper and middle lung fields. In the remaining two cases however, lesions were found homogeneously throughout the whole lung. In order to analyze the site of the lesions in the secondary pulmonary lobule, a specimen obtained from an open lung biopsy was inflated and fixed using fixative by Heitzman's method. Observation of the slices of the specimen by dissection microscope and their soft X-ray radiographs demonstrated that the lesion existed in the central area of acini. However, CT of the patient before open lung biopsy didn't showed centriacinar distribution. The disparity is because a certain number of lesions lobule is necessary to identify the centriacinar pattern by CT.     

非典型性老年人肺结核X线、CT诊断与病理分析

目的：提高对非典型性老年人肺结核X线、CT诊断的再认识,以减少误诊。方法：对116例非典型性老年人肺结核病例资料较完整地进行综合分析并总结。结果：肺不张17例,X线表现为肺叶或肺段实变、肺体积缩小,误诊为肺癌9例;CT表现呈三角形或＂V＂形,尖端指向肺门的软组织阴影,误诊为肺癌6例。肿块型12例,X线表现肿块有分叶,周边见少许斑点状钙化,8例伴肺门增大者误诊为肺癌;CT表现为肿块边缘光滑,有分叶及短毛刺,肿块中心呈斑片状钙化,误诊为肺癌。干酪性肺炎52例,X线、CT表现为肺叶或肺段大片实变,其内密度不均。混合型35例,X线、CT表现为渗出、增殖、纤维条索状,结核瘤呈多形性,肺叶内1～2 mm粟粒性结节。结论：综合分析X线、CT及支气管镜检病理表现对于减少误诊具有重要的价值。     

煤矽肺并发肺癌16例的尸检病理分析

目的 探讨煤矽肺并发肺癌的临床病理特点.方法 对16例生前诊断为尘肺0＋的煤尘接触工人并发肺癌者的尸检资料采用HE、组织化学、免疫组化染色进行回顾性分析.结果 16例患者均为男性,年龄46～57岁（平均52.8岁）,尸检肺内可见不同程度的煤尘沉积和煤尘纤维灶,煤矽结节检出率为93.75%（15/16）,15例病理诊断为Ⅰ期煤矽肺,1例为煤矽尘性反应;16例肺癌中鳞状细胞癌5例、小细胞未分化癌5例、肺泡细胞癌3例、腺癌2例、腺鳞癌1例.煤矽肺并发肺癌最明显的特点是癌组织位于煤尘纤维灶和纤维化病变旁或与尘肺病变混合存在.免疫组化结果除2例未分化癌表达神经源性标记外,余均表达上皮性标记物.波形蛋白可显示纤维成分.结论 部分肺癌的发生可能与纤维化病变有关.接尘工人可患与普通人群组织学类型相同的癌.PCNA和Ki67可作为预测患者预后的指标,波形蛋白可作为煤尘纤维灶中纤维成分的标记物.     

Specific toxicity and crystallinity of alpha-quartz in respirable dust samples

alpha-Quartz dust of respirable size--on inhalation--deposits in the lung, where it may remain for long duration and be a risk factor in the development of silicosis and (with increasing weight of evidence) lung cancer in humans. The risk assessment for these end points is fundamentally based on those properties of alpha-quartz that allow it to persist over time in the lung. For individual samples of respirable alpha-quartz it is likely that the specific toxicity of the alpha-quartz in the sample is related to this residence time, which, in turn, will be a function of its crystallinity because of the latter's potential influence on alpha-quartz's cytotoxicity and solubility. Current X-ray powder diffraction technology allows for the routine assessment of diffraction line broadening by measuring the full-width-at-half-maximum (FWHM) of a diffraction line. The FWHM for any accessible alpha-quartz diffraction line in a sample can then be used to directly assess Murata and Norman's Crystallinity Index for the alpha-quartz. This method greatly enhances the practicability of determining alpha-quartz crystallinity on individual respirable dust microsamples collected by personal sampling. It is likely that the Crystallinity Index will prove to be a useful measure of the specific toxicity of alpha-quartz and, hence, find incorporation into the risk assessment for alpha-quartz exposure.     

传染性非典型肺炎31例胸部X线影像表现

目的研究传染性非典型肺炎影像特点。为今后该病的诊断提供X线诊断依据。方法回顾性分析研究31例临床诊断为传染性非典型肺炎患者胸部X线检查结果。结果从发热到出现胸部X线异常影像平均为4.2d,从出现异常影像到极期(X线影像最重的1d)平均为6.4d,从极期到大部或基本吸收消散平均为8d。有28例双侧中、下肺野出现不同程度的阴影,占90.3%;有16例早期表现为雾状、磨砂玻璃样浅淡阴影,占51.6%;全部病例均为多叶、多节段受损,占100%;有12例遗留条索状、网格状、蜂窝状阴影,占38.7%。结论传染性非典型肺炎发病后数天内胸片可无异常改变;大多数患者肺损害为多叶,多节段;胸片影像表现四不象,呈多种肺部炎性疾病影像表现;胸片阴影多发部位在中下2/3肺野;一部分患者遗留肺纤维化;胸部CT检查可早期发现病灶。     

Angular and fibrous particles in lung in relation to silica-induced diseases

Introduction: The lung concentration of angular and fibrous particles was measured in cases of lung fibrosis only, in cases of lung fibrosis and lung cancer, and in cases of lung cancer only. These patients worked in different trades (mining, foundries, construction and were not a homogeneous group of exposed workers. Material and methods: Particles, both angular and fibrous, were extracted from lung parenchyma by a bleach digestion method, mounted on copper microscopic grids by a carbon replica technique, and analyzed by transmission electron microscopy (TEM) and energy-dispersive spectroscopy (EDS). The quartz concentration was also determined by X-ray diffraction (XRD) on a silver membrane filter after extraction from the lung parenchyma. Results: (1) Lung cancer and lung fibrosis cases retained more metal-rich particles (P=0.02) and more angular particles of all sorts (P=0.009) than did lung fibrosis cases only, and the differences were statistically significant. (2) However, more quartz was retained in the lungs in lung fibrosis cases than in lung fibrosis or lung cancer cases, but the difference in the concentrations was not statistically significant. (3) More ferruginous bodies were retained in the lungs in lung cancer and lung fibrosis cases than in cases of lung fibrosis only, and the difference in the concentrations was statistically significant (P=0.02). Conclusion: Results obtained from lung tissue must always be interpreted cautiously. However, these results are consistent with the hypothesis that workers in some trades such as foundries were exposed not only to quartz but also to asbestos, ceramic fibers, metal-rich non fibrous particles, and other likely carcinogenic chemicals. The wide range of particle types identified in the lungs of these workers illustrates the complexity of trying to determine disease origins in these work environments. Epidemiology studies have to control for the exposure to these carcinogens as well as for smoking habits. Received: 8 April 1997 / Accepted: 11 December 1997     

经皮肺穿刺活检与经支气管肺活检诊断价值的对比分析

目的评价两种肺活检方法对肺部常见疾病的诊断价值。方法回顾性分析一组52例X线引导经支气管肺活检和另一组38例CT引导经皮肺穿刺活检之间病理确诊阳性率之差异。结果2组患者获取标本的成功率均为100%,部分患者因取材量少,病理结果无诊断意义。经皮肺穿刺活检确诊率明显高于经支气管肺活检组,除2例患者有轻度气胸外,未发生其他不良反应。结论经皮肺穿刺活检是一种安全、有效、准确、损伤小的诊断方法,应当首选。     

Identification of a particular amphibole asbestos fiber in tissues of persons exposed to a high oral intake of the mineral

Samples of liver, jejunum, and lung tissue from each of 32 persons with long-term, high-level oral exposure to a ferromagnesium silicate amphibole asbestos were ashed, and the residue was analyzed by means of transmission electron microscopy with selected area electron diffraction, and energy dispersive X-ray analytic techniques. Fibers of the type ingested were identified in the tissues of 29 of the 32 persons. Among 21 controls, the tissues of only 2 subjects contained this type of fiber—in each, a single fiber from a single tissue specimen. Chrysotile asbestos fibers were found in all tissues in most of the subjects studied.     

Asbestos exposure during brake lining maintenance and repair

Data obtained on asbestos exposure of garage mechanics during brake lining maintenance and repair work show that fiber concentrations frequently in excess of regulated limits are common. The presence of chrysotile, ranging from 2 to 15%, in brake drum dusts, was demonstrated by X-ray diffraction, transmission electron microscopy, selected area electron diffraction, and electron microprobe analyses. Unaltered chrysotile was found, both in fiber and fibril form, in air and brake drum dust samples. The chrysotile asbestos content of personal air samples, taken during automobile brake repair work, was measured both by optical and electron microscopic techniques. While a positive correlation exists between the types of measurements, the present technique of optically counting asbestos fibers may considerably underestimate the levels of total asbestos exposure.     

The method used to sample ulcers influences the diagnosis of cutaneous leishmaniasis

Before beginning treatment for cutaneous leishmaniasis, parasitological confirmation of the disease is required. The most commonly used diagnostic procedures are microscopy and culture of samples taken from the active edge of the lesion. In this study, we compared the sensitivity of previous diagnostic procedures with the polymerase chain reaction (PCR), using smears taken from the edge of the lesion and its centre. The sensitivity was greater with smears taken from the centre of the lesion, both for microscopical examination (85%) and for PCR (81%), compared to those obtained from the edge of the lesion (69% and 58% respectively). When PCR was carried out on biopsy material from the edge of the lesion the sensitivity was 63%.     

Occupational magnetic field exposure, cardiovascular disease mortality, and potential confounding by smoking

PURPOSE: To assess the relationship between occupational magnetic field (MF) exposure and cardiovascular disease (CVD) mortality and to determine whether smoking could confound this relationship. METHODS: Death certificate and proxy respondent information from the US 1986 and 1993 National Mortality Followback Surveys (NMFS) were used to determine whether job titles with potential occupational MF exposure were risk factors for CVD mortality and whether smoking behavior may confound the observed relationship. A qualitative MF exposure matrix was developed based on job titles and published exposure measurements. In a case-control analysis, logistic regression models, adjusting for age, sex, race, working status, level of education, and survey year, were used to examine the associations between estimated MF exposure and death from CVD. To assess the effect of adjustment for smoking, we conducted our analyses with and without including smoking-related variables in the models, and evaluated the change in CVD risk estimates. RESULTS: There was no consistent dose-response relationship between occupational MF exposure estimates and CVD mortality. Adjustment for smoking behavior did not appreciably change the observed MF exposure-CVD mortality relationship. CONCLUSIONS: Although limited by self-reported information on exposure and smoking, our results suggest that CVD mortality was not associated with MF exposure in this study, and smoking behavior was not an apparent confounder of the MF-CVD association.     

Morphological consideration of the bronchial arteries and its interventional angiography

The authors dissected the bronchial arteries macroscopically in 40 human adults. (1) Two right and two left bronchial arteries were most commonly observed in 19 cases (48%). (2) Besides the intercostobronchial artery, one more right bronchial artery was mainly distributed to the lower lobe of the right lung. (3) Relationship between the intrapulmonary distribution of each bronchial artery and the lobe of the lung was not definite. Technological considerations of the BAG were presented from the results of this study.     

Clinical, radiological, and pathological investigation of asbestosis

By the radiological examination, differential diagnosis of asbestosis from chronic interstitial pneumonia such as IPF/UIP is difficult. The pathological features of asbestosis show the peribronchiolar fibrosis which suggest that asbestos fibers cause the inflammation of bronchioli. Therefore, the criteria for pathological diagnosis of asbestosis in 2010, contain the finding of peribronchiolar fibrosis again. Chest CT scanning including HRCT for total of 38 cases clinically diagnosed asbestosis were reviewed by 3 radiologists and one pulmonologist. On the other hand, the histology of lung tissues obtained by surgery or autopsy were examined by 4 pulmonological pathologists. Furthermore, the content of asbestos bodies in the lung was counted by phase-contrast microscopy. Thirteen cases were definitely diagnosed of asbestosis in the image including HRCT and 17 cases were diagnosed by the histopathological examination showing lung fibrosis with peribronchiolar fibrosis. Only 10 cases were indicated asbestosis by both the radiological and histopathological examinations. The mean value of asbestos bodies for these cases, was 2,133,255 per gram of dry lung tissue.     

The limited detection of lung cancer on chest X-rays

In a study of everyday clinical practice, the diagnosis 'lung cancer' was not made on the chest X-ray initially in one-fifth of the cases, even though in retrospect the lesions had been visible on the chest X-ray. In nearly half of these cases, the diagnosis had been missed at least twice on succeeding X-rays of the patient in question. Most often, superimposed structures are responsible for having missed lesions on the chest X-ray; this was the case in 71% of the patients in whom a lesion was missed. The intra- and inter-observer variation in the detection of small tumours on the chest X-ray are quite large (kappa: 0.38 and 0.48, respectively). Providing clinical information or previous chest X-rays for purposes of comparison does not improve the observer performance. Separate evaluation by two assessors ('double reading') also does not improve the results significantly. Simultaneous evaluation ('dual reading') improves the sensitivity slightly (from 28 to 37%), but has hardly any effect on the specificity (from 93 to 92%), thus improving the results somewhat. The results with computed tomography are much better (high sensitivity but low specificity). A CT-scan of the chest seems indicated in case of a suspicion of lung cancer and/or when there is a (slight) suspicion of lung cancer on the basis of the chest X-ray.     

The toxicity of N,N-dimethylformamide (DMF)

Industrial use of N, N-dimethylformamide (DMF) is increasing in recent years. The toxic properties of this substance are reviewed from the standpoint of industrial hygiene. Hepatotoxicity has been emphasized by many authors. Care should be taken against the skin absorption of DMF. N-methylformamide (MF) was identified as the major urinary metabolite of DMF. Measurements of MF in urine have been found effective as a means of biological monitoring of DMF exposure.     

工频磁场辐照导致细胞连接蛋白Cx43的异常移位

目的　研究 5 0Hz正弦磁场对细胞连接蛋白Cx4 3移位的影响 ,以探索极低频磁场 (ELFMF)抑制细胞间隙连接通讯 (GJIC)的机制。方法　用 5 0Hz、0 .8mT的正弦磁场和 (或 )十四酰基咐哌醇酯 (TPA ,5ng/ml)对培养的中国仓鼠肺成纤维细胞 (CHL)处理 2 4h(其中TPA处理 1h)。采用间接免疫荧光细胞化学法和激光共聚焦显微镜进行连接蛋白Cx4 3定位的测定 ;采用Westernblot方法检测胞浆和核内Cx4 3蛋白的含量。结果　正常组细胞间连接处有明亮的点状标记 ,连接成线 ;TPA处理组、0 .8mT正弦磁场单独作用组及 0 .8mT正弦磁场联合TPA处理组细胞的连接处标记斑点均较正常组减少 ,大量Cx4 3蛋白标记斑点出现在胞浆内 ,且在核附近聚集。各组核内Cx4 3蛋白条带很淡 ,而胞浆内Cx4 3蛋白含量ELF组 (2 .0 3± 0 .89)和TPA组 (2 .4 3± 0 .82 )明显增加 ,与正常组 (1.0 4± 0 .17)相比 ,差异有显著性 (P <0 .0 1)。结论　 5 0Hz正弦磁场直接和 (或 )协同TPA抑制体外培养细胞GJIC功能与细胞连接蛋白Cx4 3内移至胞浆有关     

Asbestos bodies or fibers and the diagnosis of asbestosis

A committee of the College of American Pathologists has proposed that the diagnosis of asbestosis requires fibrosis in respiratory bronchiolar walls and the presence of asbestos bodies (ABs) in tissue sections. To determine whether histologic ABs reliably reflect asbestos fiber concentrations in asbestosis, we compared the concentration of ABs in histologic sections to concentrations of ABs and fibers in tissue extracts of 14 asbestos workers with nonspecific interstitial fibrosis. ABs in histologic sections and extracts correlated well, r = 0.95. Counted and classified by electron microscopy, electron diffraction, and X-ray spectroscopy, commercial amphibole fibers (r = 0.94) also correlated well with ABs, but noncommercial amphiboles (r = -0.02) or chrysotile (r = 0.29) did not. In five subjects with a high percentage of noncommerical amphibole fibers, fewer than 0.5 histologic ABs/cm2 were present despite a total amphibole concentration that was similar to that in subjects with more histologic ABs. We conclude that ABs will be scarce or absent in histologic sections from some subjects with asbestosis, and that for such subjects, extracts of asbestos fibers should yield over 500,000 total amphibole fibers/g dry lung to signify that interstitial fibrosis may be caused by asbestos.     

CT pathologic correlative study of diffuse panbronchiolitis

We studied CT-pathologic correlations of diffuse panbronchiolitis. The CT images of five DPB patients were compared with inflated lung specimens taken from three open lung biopsy, one lobectomy and one autopsy. The specimens were observed using a stereomicroscope, contact radiographs and histological section. All cases were diagnosed histologically by the presence of unit lesion of panbronchiolitis. The CT findings of DPB were: 1. diffuse small rounded and linear opacities, 2. dilation of small bronchi and bronchioles, 3. bronchial wall thickening. Because small rounded opacities on the CT images were usually separated from the pleura and PV shadows (the edge of secondary lobules) as a constant distance (2 to 3 mm), they were distributed in centrilobular regions. They corresponded to the collection of foamy histiocytes and lymphoid cells, where the unit lesion of panbronchiolitis were included. Although peripheral airways could never be seen in normal CT images, small linear opacities or enlarged peripheral vascular opacities just continuous with small rounded opacities corresponded to bronchioles dilated with intrabronchial secretion. In addition, peripheral airways were sometime seen to be dilated in CT images. Cylindrical airway dilation was more prominent in the peripheral portion of airways in both CT images and lung specimens. Thickening of bronchial wall observed in CT of a case could not be confirmed in lung specimen, in which probably intrabronchial secretion might contribute to bronchial wall thickening. From the viewpoint of diagnosis, the problem is that small nodular shadows are too large to show respiratory bronchiolitis itself. Moreover, because bronchiectasis is often found in the cases of DPB, the relationship between DPB and other causes of bronchiectasis should be evaluated.