肝穿刺活检对肝硬化诊疗的意义

目的 探索肝穿刺活检对肝硬化诊断的意义.方法 对2012年9月至2013年10月我院收治的126例疑似肝硬化患者进行B超检查,采取B超定位,组织切割针获取肝脏标本,进行细胞学及病理组织检查.比较病理诊断结果与临床诊断结果的检出率并观察肝穿刺活检术后不良反应发生情况.结果 126例疑似患者中,67例确诊为肝硬化患者,其中临床诊断为失代偿期肝硬化患者27例（40.30％）,病理诊断为失代偿期肝硬化患者29例（43.28％）,两者对比差异无统计学意义（P＞0.05）;临床诊断为代偿期肝硬化患者31例（46.27％）,病理诊断为代偿期肝硬化患者32例（47.76％）,两者对比差异无统计学意义（P＞0.05）;临床诊断为肝硬化患者58例（86.57％）,病理诊断为肝硬化患者61例（91.24％）,两者对比差异无统计学意义（P＞0.05）.肝穿刺活检术术后局部疼痛14例（20.90％）,血压一过性下降5例（7.46％）,局部过敏3例（4.48％）,局部轻度红肿1例（1.49％）.结论 肝穿刺活检对肝硬化诊断符合率高,不良反应少,适应性好,值得临床上广泛应用.     

女性隐性乳腺癌临床分析及文献复习

目的 探讨女性隐性乳腺癌的发病特点、诊断、分期、治疗方法及临床预后.方法 对46例女性隐性乳腺癌患者的临床、病理及随访资料进行回顾性分析.结果 46例患者均以腋窝肿块为首发症状且均予手术治疗.手术方式为单纯腋窝肿块切除术2例,明确病理诊断后,联合化疗无效,分别于术后5个月和1年出现远处转移,失去手术机会,1例仍在化疗中,另1例失访;行乳腺癌根治术或改良根治术44例.45例获随访1～22年,其中已生存3年33例,5年18例,10年8例.结论 对原因不明的腋窝肿块,应考虑到隐性乳腺癌的可能,应予切除并送病理检查确诊.腋窝淋巴结转移癌的组织学结构和免疫组织化学指标(激素受体)对隐性乳腺癌能提供重要线索.一经确诊,宜行乳腺癌根治术或改良根治术,术后辅助性放疗、化疗.对于激素受体阳性者给予辅助性内分泌治疗.另外,术后找不到原发灶的患者要比找到原发灶的患者预后好.     

分析CT与MRI在介入治疗肝癌后癌肿残留及复发中的早期诊断效果

目的:探讨分析C T与M R I在介入治疗肝癌后癌肿残留及复发中的早期诊断效果.方法:回顾性分析2020年1月～2021年6月在本院治疗的60例原发性肝癌患者的临床资料,共有104个病灶,均行经导管肝动脉化疗栓塞术(TACE)后2～6个月来院复查,进行CT与MRI检查,CT检查为对照组,MRI检查为观察组,以数字减影血...     

Thorium dioxide effects in man. Epidemiological, clinical, and pathological studies (experience in Portugal)

The Portuguese Thorotrast series comprises 1230 traced individuals of a total of 2432 who received Thorotrast for diagnostic purposes between 1930 and 1955, and have been followed since then. Of those, 1039 received the drug systemically (most of them for cerebral angiography), and 191 locally.Among the 1230 traced cases, 901 individuals have died up to 31 December 1971, 23 from fatal blood dyscrasias (12 of which were acute leukemias), 104 from malignant tumors, 64 of which were liver tumors, the hemangioendotheliomas being the most frequent histological type found; 23 from liver cirrhosis and 13 from the late effects of cervical granulomata occurring after cerebral angiography.The follow up of these cases and of 726 controls roughly matched for age and sex, and the statistical analysis performed on the results have shown that the incidence of malignancies in general, particularly of acute leukemias and malignant neoplasias of the liver and of liver fibrosis (liver “cirrhosis”) was significantly higher among the traced Thorotrast cases than among the controls and the general Portuguese population, even allowing for the peculiarities of the diseased series, after correction of the respective death rates by a calculated factor.The clinical symptoms more frequently found among the patients still alive, besides the local complaints due to “granulomata,” were general gastrointestinal complaints and also pain in the right and/or left upper abdomen. Laboratory tests have disclosed an appreciable percentage of abnormal results of the protein electrophoresis, with low serum albumin (in 70% of the cases) and increased α₂ (in 67.7%) and γ (in 69.6%) globulins and of an increased level of alkaline phosphatase (in 68.4% of the cases). In a few cases special studies, such as bone marrow, chromosome, and body burden determination studies have been made.The main morphological lesions found in pathological studies of this series (autopsies and biopsies) are local granulomata developed in the tissues where the drug had been spilled, liver fibrosis, and liver tumors. Of these, the most frequent types found are hemangioendotheliomas and cholangiocarcinomas. A multicentric hemangioendothelioma was found in the reticuloendothelial organs in 3 cases. Bone marrow lesions found have been leukemias or aplastic anemias.The authors conclude that Thorotrast must have been the cause of such pathological consequences, probably through its radioactivity, and therefore should not be used in human beings.     

肝硬化患者再生结节与小肝癌运用MR和CT检测诊断效果分析

目的:探讨肝硬化患者再生结节与小肝癌运用MR和CT检测诊断效果.方法:选取2016年1月~2016年12月收治的80例肝硬化患者作为研究对象,其中再生结节共34例、小肝癌共46例,均采用MR和CT检测,且对检测后确诊率进行观察及评估.结果:34例肝硬化再生结节患者的经MR检查后确诊率为94.12%;经C T检查后确诊率64.71%.46例肝硬化小肝癌患者经MR检查后确诊率为95.65%,经CT检查后确诊率为76.09%.影像学上,MR能够更加清晰地显示病灶组织.结论:MR与CT检测技术应用于再生结节、小肝癌中具有较高的临床价值,但是前者优势更大,能够更加清晰地显示病灶组织,继而为肝硬化患者的再生结节与小肝癌鉴别提供客观依据.     

15例肝小静脉闭塞病患者的诊断

目的探讨肝小静脉闭塞病(hepatic veno-occlusive disease,HVOD)的诊断方法。方法回顾性分析本院2010年~2015年确诊HVOD的15例肝小静脉闭塞病的临床和病理资料。结果 15例患者CT平扫表现为肝脏增大,肝实质密度均匀减低,增强呈"地图状"强化,门脉期明显;肝静脉及下腔静脉肝段变细,肝静脉显示欠清晰。病理学表现为肝窦淤血、扩张,肝细胞出现不同程度变性、坏死。结论病理检查对确诊肝小静脉闭塞病影像诊断有重要价值,CT增强检查是诊断肝小静脉闭塞病的有效方法。     

血清肿瘤相关物质（BXTM）检测在恶性肿瘤中的应用

目的对比分析血清肿瘤相关物质（Bo Xin serum tumor associated material,BXTM）在不同人群中的含量差异,探讨BXTM在肿瘤筛查、鉴别以及诊断中的临床应用价值。方法采用化学比色法检测70例恶性肿瘤患者、42例良性病变患者、28例肿瘤术后患者以及40例体检自愿者BXTM的血清水平,比较各组的BXTM水平的差异。同时测定30例原发性肝癌的AFP的浓度,24例结肠癌的CEA的浓度,比较它们与BXTM水平的相关性。结果 70例恶性肿瘤包括肺癌、肝癌、结直肠癌、乳腺癌、胃癌、食道癌、卵巢癌、血液系统肿瘤、泌尿系统肿瘤、神经系统肿瘤,恶性肿瘤组BTXM均值为（109.56±21.47）U/ml,敏感率为82.8%;良性病变组BXTM的均值为（96.35±20.82）U/ml,阳性检出率为42.8%;体检自愿者BXTM的均值为（81.16±10.03）U/ml,阳性检出率为10.0%,特异性为90.0%。恶性肿瘤患者的BXTM的浓度以及阳性率均明显高于良性病变和体检自愿者的浓度（P〈0.05）。结论血清BXTM检测具有较高的敏感性、特异性和广谱性,临床上可用作恶性肿瘤筛查、鉴别以及诊断的参考指标。     

Sacral insufficiency fractures: a report of two cases and a review of the literature

Sacral insufficiency fractures (SIF) are a type of stress fracture that occur primarily in postmenopausal women. They were first described in 1982 by Lourie and have since been frequently overlooked as a cause of low back, buttock, or groin pain. We present two cases of SIF to demonstrate the clinical presentation, diagnosis, and treatment of patients with SIF. Both patients were elderly women with complaints of pelvic and low back pain in the absence of significant trauma. Physical examination was significant for marked sacral tenderness. Diagnostic imaging supported the diagnosis of SIF. Both patients underwent early rehabilitation, including early ambulation, and had good functional outcomes. These patients serve to illustrate how conservative treatment yields excellent clinical results in the majority of patients, with most reporting improvement within 1-2 weeks after fracture and complete resolution of symptoms after 6-12 months of treatment.     

Effect of alcohol consumption on the progression of hepatitis C virus infection and risk of hepatocellular carcinoma in Japanese patients

Chronic hepatitis C virus (HCV) infection is associated with a spectrum of liver diseases and a proportion of chronic cases progress through cirrhosis to hepatocellular carcinoma (HCC). The viral and host factors that are important in the clinical and histological progression of HCV infection are unclear. We investigated the effect of moderate (<80 g/day) and heavy (>80 g/day) alcohol intake on the histological and clinical progression of HCV infection and their associated risk of hepatic cancer in a group of Japanese patients. A number of other variables were assessed to evaluate their impact on disease progression. We recruited 120 patients with HCV infection and categorized them into four groups, based on alcohol consumption pattern. All clinical and biochemical profiles were collected from recorded files. Liver biopsies were analysed for the degree of fibrosis, presence of cirrhosis and histological activity of necroinflammation. Hepatic tumours were detected by the follow-up imaging analysis. There was no difference in the age, length of exposure to HCV infection and HCV RNA serum levels in the alcohol and alcohol-free groups. The histological grading of necroinflammation, serum levels of alanine aminotransferase and HCV RNA did not have any correlation with each other in the alcohol and alcohol-free group. There was a 1.5-2. 5-fold greater risk of liver cirrhosis and hepatocellular carcinoma in the alcohol intake group compared to the alcohol-free group. Kruskal-Wallis analysis among four groups demonstrated a significant transition to fibrosis (P < 0.05) for alcoholics with HCV infection. The increased risk of liver cancer in the alcohol group is independent of size and growth of tumours. The clinical manifestations of gastro-oesophageal variceal bleeding, ascites, and encephalopathy were also higher in the alcohol intake group. Alcohol consumption is an important risk factor in the histological and clinical progression of HCV infection and has no relation with HCV replication. Chronic HCV carriers should avoid excessive alcohol intake to reduce the acceleration of liver disease and risk of liver cancer.     

慢性乙型肝炎患者血生化指标和血清病毒标志与肝组织病理的相关性研究

目的探讨慢性乙型肝炎（CHB）患者血生化指标和血清病毒标志与肝组织病理的关系。方法对132例CHB患者行肝穿刺活检,进行组织炎症活动度分级（G）和纤维化程度分期（S）,同时检测患者血清总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（y-GT）、总胆汁酸（TBA）、白蛋白（ALB）和血清病毒标记物乙型肝炎病毒e抗原（HBeAg）、乙型肝炎病毒脱氧核糖核酸（HBV—DNA）。结果血清TBIL,ALT、AST、y—GT、TBA平均值随病理分级和分期的增加而逐渐升高,ALB则相反,与肝炎症分级和肝纤维化分期之间有明显相关（P〈0．05）;HBehg的表达与肝炎症分级和肝纤维化分期之间无明显相关（P〉0．05）;HBV—DNA水平与肝炎症变化和纤维化分期无明显相关（P〉0．05）。与病理诊断比较,临床诊断的灵敏度分别为：轻度74．24％（49例）,中度60．38％（32例）,重度53．85％（7例）。结论血清TBIL、ALT、AST、γ—GT、TBA可反映CHB患者肝组织炎症活动的程度;ALB是慢性乙型肝炎病变进展的指标。血清HBeAg的表达和HBV—DNA水平与肝组织病理炎症分级和纤维化分期之间无明显相关性。仅凭血生化指标、血清病毒复制活跃与否判断肝病活动性是不全面的,应将肝组织病理作为判断肝炎活动性和是否抗病毒治疗的主要依据。     

同型半胱氨酸在原发性肝癌中的表达及意义

目的探讨血清同型半胱氨酸(homocysteine,Hcy)在原发性肝癌(Primary hepatic carcinoma,PHC)中的表达及其意义。方法分别测定113例原发性肝癌、80例肝硬化患者和50例正常体检者血清中的Hcy的水平,并进行相关的统计学分析。结果原发性肝癌和肝硬化组血清Hcy水平明显升高(P﹤0.01～0.05),且随着Child分级的升高而递增。结论同型半胱氨酸(Hcy)是反映原发性肝癌肝功能损害的敏感指标,对PHC早期诊断、疗效判断、预后监测有重要的临床意义。     

血清TBA、AST/ALT比值的测定在肝病诊断中的临床意义

目的探讨血清胆汁酸（total bile acids,TBA）活性、天门冬氨酸氨基转移酶（aspartate aminoxansferase,AST）与丙氨酸氨基转移酶（alanine aminotransferase,ALT）的比值（AST/ALT）在肝病诊断和鉴别诊断中的临床意义。方法选择本院住院肝病患者169例（急性肝炎38例、慢性肝炎65例、肝硬化45例、原发性肝癌21例）,采用东芝TBAI-120RF全自动生化分析仪测定健康人和肝病患者血清中TBA、AST/ALT的值,并对结果进行分析和统计学处理。结果各肝病组血清中TBA活性均显著高于正常对照组（P〈0.01）,且以急性肝炎最高,肝硬化次之,即急性肝炎〉肝硬化〉原发性肝癌〉慢性肝炎,除原发性肝癌组与慢性肝炎组之间差异无统计学意义（P〉0.05）外,其余各肝病组之间差异均有统计学意义（P〈0.01或P〈0.05）;肝病组AST/ALT比值与正常对照组间差异均有统计学意义（P〈0.01）,各肝病组间AST/ALT比值差异均有统计学意义（P〈0.01）。结论血清TBA、AST/ALT比值不仅可反映肝细胞受损的情况,还可对肝病的诊断、鉴别诊断、疗效观察及预后判断提供依据。     

四川泸州地区贫血患儿地中海贫血筛查和基因诊断结果分析

目的 分析四川泸州地区地中海贫血的发病率及基因突变类型和构成比。方法 对泸州地区556例贫血患儿采用红细胞渗透脆性、血清铁蛋白、血红蛋白电泳进行筛查,筛查阳性者应用PCR方法结合DNA芯片杂交技术以及反向斑点杂交法分别进行α、β-地中海贫血基因突变位点分析。结果 556例贫血患儿中,地贫筛查阳性176例(阳性率31.65%),基因诊断阳性136例(阳性率24.46%),其中α-地贫53例,β-地贫81例,α合并β地贫2例。53例α-地贫患儿共检出7种突变基因型,其中--α^SEA/αα缺失型占39.62%,-α^3.7/αα缺失型26.42%。82例β-地贫患儿共检测出7种基因突变类型,有14种基因组合形式。其中以CD17(A→T)、IVS-Ⅱ-654(C→T)和CD41/42(-TTCT)最多见。结论 四川泸州地区地中海贫血基因突变发生率较高;基因诊断是确诊地中海贫血的重要标准。     

肿瘤特异性生长因子测定在肝癌及肝硬化诊断中的意义

目的研究肿瘤相关物质肿瘤特异性生长因子(TSGF)在肝癌、肝硬化及健康对照之间的差异性,从而探讨TSGF在肝癌与肝硬化诊断中的意义。方法采用光电比色法检测53例肝癌患者治疗前后以及66例健康体检者、60例肝硬化患者血清中TSGF的含量,并进行对比分析。结果肝癌治疗前TSGF明显高于对照组(t=31.67,P<0.01)及肝硬化组(t=12.77,P<0.01)。肝癌组治疗后与治疗前相比,TSGF明显降低(t=10.215,P<0.01)。结论血清TSGF测定对肝癌诊断具有较高的敏感性,且在监测治疗效果、转移及复发、人群普查等方面具有较大的实用价值。     

AU5800全自动生化分析仪用于脂肪肝诊断中的效果观察

目的:观察AU5800全自动生化分析仪用于脂肪肝诊断中的效果。方法:选择2018年9月~2019年9月笔者医院腹部B超诊断的86例脂肪肝患者作为观察对象,以同期健康体检腹部B超正常的86例对象为对照组,所有人员均使用AU5800全自动生化分析仪行血清肝功能及血脂检验,比较两组检验结果。结果:观察组患者的肝功指标包括丙氨酸氨基转移酶(ALT)、天门冬氨基酸氨基转移酶(AST),血清胆碱脂酶(CHE)水平显著高于健康体检组,具有统计学意义(P<0.05);观察组血脂检测指标包括总胆固醇(TC)、甘油三酯(TG)均有不同程度增高,组间对比有统计学意义(P<0.05)。结论:通过AU5800全自动生化分析仪检验谷草转氨酶(AST)、谷丙转氨酶(ALT)、血清胆碱脂酶(CHE)、总胆固醇(TC)、甘油三酯(TG)水平有助于诊断脂肪肝。     

胰岛细胞瘤25例外科诊治分析

目的探讨胰岛细胞瘤的临床诊断和外科治疗方法。方法对某院2001.1~2010.12收治的胰岛细胞瘤25例患者的临床资料进行回顾,结合相关文献进行诊治分析。结果 25例患者中,非功能性胰岛细胞瘤12例,功能性胰岛细胞瘤13例。肿瘤位于胰头7例,胰颈4例,胰体尾14例。肿瘤直径0.5~20cm。13例功能性胰岛细胞瘤均有Whipple三联征。全部病例术前均行B超和/或CT检查,7例术前行DSA检查。25例患者均行手术治疗,单纯肿瘤切除16例,胰体尾部切除5例,胰体尾切除加脾切除2例,胰颈部切除1例,瘤灶切除后十二指肠修补+旷置+胰头-十二指肠空肠壁吻合1例。术后发生胰漏1例。全部患者治愈出院。结论 NIT无特异临床表现,但影像学检查能较有效检出。FIT临床主要表现为典型的Whipple三联征。CT和DSA是有效的术前定位方法。手术切除是胰岛细胞瘤治疗的最佳选择。     

Two sisters with progressive familial intrahepatic cholestasis

A few months after birth two sisters aged 5 and 9 years had developed cholestasis and abnormal liver functions with symptoms including itching and jaundice. The younger sister also developed rickets and clotting disorders. On clinical, biochemical and immunohistopathological grounds the diagnosis of 'progressive familial intrahepatic cholestasis (PFIC) type 2' was made. Medical treatment was not succesfull in reducing symptoms. An ileocolonic bypass in the younger child was not effective. Subsequently, both patients underwent partial external biliary diversion (PEBD). Except for a period of intermittent itching in the younger child, both patients remained free of symptoms 2 years after PEBD. In cases where an early diagnosis is made, PEBD could delay or even prevent the necessity of liver transplantation.     

HBV-DNA, HBeAg/anti-HBe serological status in hepatitis B chronic individuals from central Italy

A population of 488 HBsAg carrier individuals, from central Italy, classified on the basis of biochemical, clinical and histological parameters, was analysed for the presence of HBV-DNA in serum and its relationship with HBeAg/anti-HBe markers. The prevalence of HBV-DNA was 32.8% in chronic patients with biopsy-proven liver disease, and 20 and 4.3% respectively in asymptomatic carriers with and without altered ALT levels. The values in chronic patients were correlated with the histological activity. Concordance of HBV-DNA presence and HBeAg positivity was observed in only 61.4% of cases. However HBV-DNA prevalence in sera of anti-HBe positive individuals was very low in asymptomatic carriers with normal ALT levels (2.5%). Higher values were observed in anti-HBe positive chronic patients (15.8%) and in carriers occasionally found with changes in ALT without any other clinical sign of illness (16.7%). These data would indicate that HBV-DNA is the serological marker which is most closely related to liver disease.     

Long term and repeated electron microscopy and PCR detection of Borrelia burgdorferi sensu lato after an antibiotic treatment

The diagnosis of Lyme disease in 18 patients has been proved by detection of Borrelia burgdorferi sensu lato when using immunoelectron microscopy or detecting its nucleic acid by PCR in the plasma or the cerebrospinal fluid. The positive results occurred in the plasma or in the cerebrospinal fluid in the period of 4-68 months after an antibiotic treatment. The typical clinical manifestations of Lyme disease were observed in 9 patients and non-specific symptoms in another 9 patients. According to presented results we can recommend repeated examination using PCR of the plasma and other biological specimens in the individuals with persistent or recurring complaints after an acute form of Lyme disease and its antibiotic treatment. Also examination of the cerebrospinal fluid with non-specific symptoms and simultaneously displayed pathology electroencephalogram and/or magnetic resonance imaging findings can be advantageous.