青年与中老年乳腺浸润性导管癌MRI增强形态类型的差异及病理基础初探

目的探讨乳腺浸润性导管癌MRI增强形态类型与年龄的相关性及其病理基础。方法收集经病理学证实的乳腺浸润性导管癌97例,均进行了MRI动态增强检查。2名放射科医生独立阅片确定肿瘤MRI增强后形态类型(肿块/非肿块样强化)及大小。2名病理科医生确定浸润性导管癌成分的组织学分级及肿瘤内是否含有导管内原位癌(ductal carcinoma in situ,DCIS)。分析MRI增强形态类型与年龄段的相关性,青年与中、老年MRI增强形态类型是否有显著差异,肿块与非肿块型乳腺癌病变大小、浸润性导管癌成份组织学分级及DCIS存在与否的差异性。结果 MRI增强形态类型与年龄显著相关(P=0.000);40岁(含)以下青年中的非肿块型乳腺癌比40岁以上中老年的明显增多(P=0.000)。非肿块型乳腺癌大小大于肿块型(P=0.022)。非肿块型乳腺癌中病理含DCIS者明显多于肿块型乳腺癌(P=0.000),且前者浸润性导管癌成分的组织学分级明显低于后者(P=0.006)。结论非肿块型乳腺癌更易发生于青年,肿块型乳腺癌更易发生于中老年。非肿块型乳腺癌与存在DCIS显著相关,但浸润性导管癌成分组织学分级相对较低,其恶性程度未必差于肿块型乳腺癌。     

微小乳腺癌的全数字化乳腺摄影诊断分析

目的 探讨微小乳腺癌的X线特征.方法 回顾性分析行全数字化乳腺摄影(FFDM)检查并经手术病理证实的41例微小乳腺癌的X线特征、病理类型及癌灶大小与淋巴结转移之间的关系.结果 41例微小乳腺癌发生于左侧乳腺22例(53.66%),右侧乳腺19例(46.34%).X线表现:肿块23例(56.10%),单纯钙化7例(17.07%),结构扭曲5例(12.20%),非对称性致密影6例(14.63%).病理学结果:浸润性导管癌34例,黏液癌1例,非特异性导管癌2例,浸润性导管内癌1例,单纯癌1例,鳞癌1例,小管癌1例.微小乳腺癌同侧淋巴结转移率(4.9%)明显低于同期大乳腺癌组(27.3%)(χ2=6.620 3,P<0.05).结论 微小乳腺癌淋巴结转移率低,全数字化乳腺摄影对诊断微小乳腺癌有重要价值.     

年轻女性(≤40岁)乳腺癌的X线摄影与MRI对照研究

目的 分析年轻女性乳腺癌乳腺X线摄影(mammography,MG)及磁共振成像(magnetic resonance imaging,MRI)影像学特点,以期提高年轻女性乳腺癌病灶的检出和评估.方法 收集经手术病理证实的121例乳腺癌患者,均于术前接受乳腺MRI检查,年轻组(≤40岁)患者29例,中老年组(>40岁)患者92例,其中共81例患者行MG检查.比较2组病例的MG特点、MRI形态学、信号强度、ADC值及血流动力学特点,以及淋巴结转移与否.采用SPSS13.0统计软件,P值≤0.05为差异有统计学意义.结果 年轻女性表现为致密型乳腺23例(79.3%),浸润性导管癌24例(82.8%),病灶平均直径为3.6 cm,肿块型病灶中表现为非毛刺状边缘14例(73.7%),不均匀强化病灶21例(72.4%),病灶伴导管内成分(extensive intraductal component,EIC)16例(55.2%),18例病灶发生腋淋巴结转移病灶(62.1%).年轻女性与中老年女性癌灶出现钙化的几率无明显差异(P=0.159),乳腺X线摄影对年轻女性组患者病灶检出的敏感性(62.5%)低于中老年女性组(87.7%)(P=0.006).结论 MRI对于年轻女性致密型乳腺中乳腺癌病灶的检出及术前评估具有极其重要的作用.     

青年乳腺浸润性导管癌动态增强MRI影像特征分析

目的探讨青年乳腺浸润性导管癌的动态增强MRI形态及强化特征。方法收集经病理学证实的乳腺浸润性导管癌并行术前乳腺MRI动态增强扫描患者71例,按年龄分为青年组(≤40岁)24例和中老年组(40岁)47例。由两名放射科医生独立阅片确定病变MRI影像特点,包括:病变位置、强化类型、形状、边界、边缘及时间信号强度曲线(time signal intensity lune,TIC)。与中老年组比较,分析青年乳腺浸润性导管癌的MR特点。结果青年乳腺癌表现为非肿块型占50%,多于中老年组,且大部分边界不清(占84.6%),两者具有显著差异(P0.05)。而病灶形态是否分叶、边缘是否光滑及TIC类型两组之间无显著差别(P0.05)。结论青年乳腺浸润性导管癌形态类型多为非肿块型,边界不清,推测与肿瘤具有更大的侵袭性及预后较差有关。     

多模态MRI对致密型乳腺中乳腺癌的诊断价值

目的：探讨多模态 MRI 上致密型乳腺中乳腺癌的影像学特征。方法收集行乳腺 X 线及 MRI 检查的120例乳腺癌病例,均为单病灶,且经手术病理证实,根据乳腺 X 线摄影 BI-RADS 分类的标准,将乳腺分成致密型(68例)和非致密型(52例)2组,对照研究2种乳腺类型中乳腺癌的 MRI 形态学特征、表观扩散系数(ADC)值(b=1000 s/mm2)、时间-信号强度曲线(TIC)间的差异。采用 SPSS16.0统计软件,P 值<0.05为差异有统计学意义。结果致密型与非致密型2组乳腺中病灶边缘毛刺分别为64.7%(44/68)、30.8%(16/52),其差异有统计学意义(P =0.000);2组乳腺癌直径分别为(1.83±0.98)cm、(1.40±0.46)cm,其差异有统计学意义(P =0.005);2组病灶呈非肿块样强化的分别为72.1%(49/68)、34.6%(18/52),其差异有统计学意义(P =0.000);2组病灶的ADC 值(b=1000 s/mm2)分别为(0.89±0.12)×10-3 mm2/s,(0.95±0.10)×10-3 mm2/s,其差异有统计学意义(P =0.016)。结论相对非致密型乳腺,致密型乳腺中的乳腺癌在多模态 MRI 表现上具有一定的特征。     

全数字化乳腺摄影与MRI对乳腺恶性病变诊断的对比分析

目的 探讨乳腺癌全数字化乳腺摄影(full-field digital mammography,FFDM)与乳腺MRI的影像学表现,评价其对乳腺癌的诊断价值.方法 收集68例经穿刺或手术病理证实的乳腺癌病例,对比分析其X线摄影及MRI表现.全数字化乳腺摄影采用常规方法摄片,MRI采用自旋回波T1WI,T2WI序列及动态增强扫描等.结果 68例乳腺恶性肿瘤中,浸润性导管癌57例,浸润性小叶癌3例,叶状囊肉瘤1例,血管肉瘤1例,导管内癌2例,炎性乳癌2例,印戒细胞癌1例,Paget's病1例.乳腺X线摄影诊断正确61例,诊断准确率89.7％.MRI诊断正确66例,诊断准确率97.1％.结论 乳腺X线摄影是乳腺恶性病变的首选检查方法,MRI能更多的显示乳腺病灶的内部特征,二者联合应用对乳腺癌的临床诊断具有重要意义.     

乳腺浸润性导管癌MR影像学征象与HER-2表达的相关性分析

目的 通过分析乳腺浸润性导管癌MRI征象与人表皮生长因子受体-2(HER-2)过表达的关系,寻找能够预测病灶的恶性程度及患者预后的MRI征象.方法 选取术前行MRI扫描且病理证实为乳腺浸润性导管癌的287例女性患者.依据乳腺影像报告和数据系统(BI-RADS)磁共振部分评估乳腺浸润性导管癌的MRI征象,通过免疫组化取得HER-2表达结果;采用卡方检验分析MRI征象和HER-2表达的相关性.结果 在287例浸润性导管癌中,HER-2表达阳性1 0 5例,阴性182例.毛刺状边缘(# =5.859,P=0.016)、环形强化(x2=5.980,P=0.014)和流出型曲线(x2=4.999,P=0.025)的比例在HER-2表达阳性时显著增高;其他MRI征象在HER-2阳性组和HER-2阴性组的比例均无统计学差异.结论 乳腺浸润性导管癌的MRI形态学和血流动力学征象与HER-2表达之间存在一定相关性,术前可以根据病灶MRI征象进行生物学行为和预后评估.     

同时性双侧原发性乳腺癌MRI表现与临床病理对照分析

目的：分析同时性双侧原发性乳腺癌(sBPBC)的 MRI 表现,并结合其病理类型进行对照分析,探讨其临床病理特点及双侧病变影像学表现的相关性。方法回顾性分析经手术病理证实的20例 sBPBC 患者的 MRI 表现,进行双侧 MRI 表现比较并与病理学类型对照分析。结果(1)20例 sBPBC 共41个病灶,病理类型以浸润性导管癌居多(26/41)。第一癌与第二癌病理类型相同者11例(11/20),其中,1例双侧浸润性小叶癌,10例双侧导管癌；不相同者9例(9/20)。(2)浸润性乳腺癌较早期乳腺癌 MRI 表现更具特征性。20例患者,仅6例(6/20)第一癌与第二癌具有相似的 MRI 表现,相似率不高；此6例患者,4例(4/6)具有相同的病理学类型。(3)10例患者符合第一癌为进展期乳腺癌,第二癌为早期乳腺癌或低度恶性乳腺癌。结论(1)sBPBC 患者的病理类型以浸润性导管癌发生率最高,双乳癌患者双侧病变病理类型不一定相同。(2)第二癌与第一癌的 MRI 表现相似率不高,双侧病变可分别独立行 MRI 诊断。(3)sBPBC 患者中,部分第一癌为进展期乳腺癌,第二癌为早期乳腺癌,影像诊断时遇到的一侧疑似乳腺癌,但另一侧表现不相似的小病灶,需要积极随访。     

乳腺癌61例X线表现及病理对照分析

目的探讨和分析乳腺癌的钼靶X线影像特点及其病理基础,提高乳腺癌的X线诊断水平。方法回顾性分析研究61例经乳腺钼靶X线摄影检查、手术及病理证实的乳腺癌患者的X线表现。结果①61例患者中,单纯肿块41例,肿块伴钙化13例,单纯钙化8例,结构扭曲5例,结构扭曲伴钙化4例,局灶性致密影5例,磨玻璃样改变1例,阴性1例。②有钙化者多见于浸润性导管癌和导管原位癌,有肿块者多见于浸润性导管癌、粘液腺癌和髓样癌,结构扭曲者和局部致密性影多见于浸润性导管癌。结论①乳腺癌常见的X线表现为单纯肿块、钙化伴肿块、单纯钙化和结构扭曲。②浸润性导管癌占乳腺癌的大部分,乳腺癌的病理基础不同,导致了不同类型的X线表现。③X线摄影对乳腺癌有很高的诊断价值,尤其对临床检查阴性的患者,但对致密性乳腺还是有一定的局限性。     

乳腺导管癌的X线表现及其病理基础

目的:分析乳腺导管癌的X线表现及其病理基础,提高对其认识.方法:搜集经手术病理证实的乳腺癌57例,包括浸润性导管癌45例,导管原位癌12例,观察X线表现并与病理结果对照.结果:①X线表现为肿块35例,钙化22例,结构致密或扭曲13例;35例肿块除2例显示边界清晰的良性征象外,其他均为恶性边缘征象的肿块;典型恶性钙化多见(18/22),且钙化除单纯钙化外可同时伴发肿块或结构致密.②45例浸润性导管癌主要表现为肿块34例,结构致密或紊乱10例,以上两者伴钙化10例.③12例原位导管癌中全部表现为典型恶性钙化,且单纯钙化均出现于原位导管癌而未见于浸润性导管癌中.结论:乳腺导管癌的常见X线表现为肿块、钙化和结构致密,单纯钙化首先考虑原位导管癌,其余征象均首先考虑浸润性导管癌.     

Glutamine supplementation in vitro and in vivo,in exercise and in immunodepression

In situations of stress, such as clinical trauma, starvation or prolonged, strenuous exercise, the concentration of glutamine in the blood is decreased, often substantially. In endurance athletes this decrease occurs concomitantly with relatively transient immunodepression. Glutamine is used as a fuel by some cells of the immune system. Provision of glutamine or a glutamine precursor, such as branched chain amino acids, has been seen to have a beneficial effect on gut function, on morbidity and mortality, and on some aspects of immune cell function in clinical studies. It has also been seen to decrease the self-reported incidence of illness in endurance athletes. So far, there is no firm evidence as to precisely which aspect of the immune system is affected by glutamine feeding during the transient immunodepression that occurs after prolonged, strenuous exercise. However, there is increasing evidence that neutrophils may be implicated. Other aspects of glutamine and glutamine supplementation are also addressed.     

Temporal changes in the oxidation state in in vitro blood

The rates at which the paramagnetic compounds deoxyhemoglobin (Hb) and methemoglobin (MHb) form in vivo within an area of hemorrhage are unknown. The present experiment establishes the baseline concentrations and rates of change in paramagnetic hemoglobin concentrations, as well as the pH in normal heparinized and clotted human blood maintained in vitro at 37 degrees C under anaerobic conditions over 30 hours. There was a moderate increase in Hb concentration in normal heparinized blood (average increase was 15.5%, rate = 0.50%/hour) and a slight increase in MHb concentration in the heparinized blood and clots (average increase was 1.4%, rate = 0.044%/hour). A second experiment was done to verify the activity of the RBC systems responsible for maintaining the hemoglobin molecule in the reduced state. Conversion of MHb to Hb in these samples proceeded at a rate of 5.6%/hour. In a third experiment, blood from 11 normal subjects maintained at 4 degrees C 25 degrees C was analyzed for MHb concentration over the course of 28 days. The level of MHb formation remained in the range of normal for at least 11 days in all subjects. The authors conclude that at basal conditions created in vitro, the blood levels of both Hb and MHb remain at relatively low levels. Therefore, if the accumulation of Hb and/or MHb occurs in acute in vivo hematomas it must be driven by intrinsic tissue factors.     

Carcinoma in situ in cryptorchid testes in post-pubertal patients]

The pathohistologic analysis of testis sections of 37 postpuberty patients with different types of cryptorchism is performed. The tissue samples were taken during orchiopehy, fixed in Bouin's solution and treated by the standard histologic techniques. The morphologic criteria are presented for identification of the presence of the so called carcinoma in situ cells found in two cases. Besides, in 13 patients rare, mainly single, atypical germinative cells were found in a smaller number of the seminiferous tubules. It has been concluded that the presence of carcinoma in situ cells in undescended testes of some patients and considering the simple way of sampling, lack of complications and high reliability of the diagnostic procedure, it is absolutely justified to take routine biopsy of testes during orchiopexy in each postpuberty and perhaps prepuberty patient.     

新时期军医学院人才培养的思考

在新的历史条件下 ,军医学院迎接未来高技术局部战争的挑战 ,适应部队武器装备的不断更新以及医学科技、社会发展对人才素质提出的新要求 ,必须在更为广阔的时空背景下找准人才培养的着眼点 ,科学确立人才培养方向 ,提高人才培养质量。现就人才培养思考如下 :1　改变教育观念 ,     

成批煤气爆燃烧伤的救治体会

报道治疗因煤气泄漏爆炸烧伤病员7例，经应用MEBT技术积极救治，其中6例于伤后17天痊愈出院，另一例特重伤员也于伤后30天康复出院。作者认为：应严格按照MEBT／MEBO要求进行规范治疗，正确处理生命体征、休克、感染、脏器功能和创面的辨证关系。同时，不能忽视外科营养在过程中的重要作用，它是创面修复的物质保证。