乳腺大汗腺癌的影像学表现

目的回顾性分析乳腺大汗腺癌的MRI及乳腺X线特点。方法收集2009年8月—2013年5月经病理证实的乳腺大汗腺癌共19例(平均年龄66.8岁,范围51~87岁)。19例中行MRI检查和乳腺X线摄影检查各13例,其中接受2种检查者7例。分析病灶在MRI上的形态学特征、动态增强特点、时间-信号强度曲线(TIC)及乳腺X线表现。结果在乳腺X线上,13例中肿块8例、结构扭曲4例、未见明显异常者1例;肿块边缘模糊者7例,毛刺者1例;4例伴有微小钙化。在MRI上,13例中10例表现为肿块样强化、3例表现为非肿块样强化;肿块边缘毛刺者6例,不规则者4例。3例非肿块样强化的分布类型分别为区域性强化1例、多区域性强化1例、弥漫性强化1例。TIC为平台型者1例、流出型者12例。结论乳腺大汗腺癌在X线上多表现为边缘模糊的肿块,在MRI上多表现为毛刺状边缘的肿块,TIC多为流出型。乳腺大汗腺癌在影像学上多表现为恶性肿瘤的征象,无特征性表现。     

乳腺癌磁共振成像形态学特征与病理的相关性研究

目的 探讨乳腺癌磁共振成像(MRI)形态学特征与病理之间的相关性.方法对96例经手术证实的乳腺癌患者的乳腺MRI图像与术后病理类型及组织学分化程度进行回顾性分析.MRI检查使用德国西门子公司Magnetom Avanto1.5T磁共振扫描仪;专用双穴乳腺表面线圈.于动态增强早期进行形态学观察,包括肿瘤形状(分叶形、类圆形、不规则形)、大小(≤2 cm、>2～5 cm、>5 cm)、数目(单发、多发)、边缘(光滑、不规则、毛刺)及信号强度.结果乳腺浸润性导管癌与浸润性小叶癌多呈分叶形或不规则形,边缘不规则或可见毛刺征,两者在形状及边缘特征上差异均有统计学意义(P<0.01).髓样癌多呈类圆形,边缘光滑.浸润性小叶癌多为多灶性,浸润性导管癌和髓样癌多为单发.乳腺癌的大小在各病理类型组中分布差异无统计学意义(X2=2.090,P>0.05).乳腺浸润性导管癌、浸润性小叶癌的MRI形态学特征与不同组织学分化程度之间差异无统计学意义(P>0.05).结论根据乳腺癌MRI形态学特征预测肿瘤的病理类型及组织学分化程度尚有一定难度,但某些病理类型的乳腺癌MRI形态学表现具有一定的特征性.     

三阴性乳腺浸润性导管癌的MRI影像学表现

目的探讨三阴性乳腺浸润性导管癌的MRI特征。方法收集2011年1月—2012年12月在3.0T MRI检查,且获得病理证实的浸润性导管癌共234例,其中三阴性乳腺癌78例、非三阴性乳腺癌156例。回顾性分析其临床及MRI资料。根据美国放射学会的乳腺报告及数据系统标准评估其MRI表现,记录病灶形态(非肿块/肿块)。若为肿块,则继续从肿块形状(圆形/卵圆形/分叶状/不规则形)、边缘(光滑/不规则/毛刺)、内部强化特征(均匀/不均匀/环形)等方面进行分析,同时记录病灶数目(单灶/多灶)。若为非肿块,则分析病灶分布形式(段样/区域样/弥漫)、内部强化特征(不均匀/点簇状/网状)。在T2WI上记录病灶信号特点(低或等/高/高亮)。采用单因素及多因素分析三阴性乳腺癌与非三阴性乳腺癌的差异。结果 78例三阴性乳腺癌中,69例为肿块样强化、9例为非肿块样强化。156例非三阴性乳腺癌中,120例为肿块样强化、36例为非肿块样强化。单因素分析显示,三阴性乳腺癌与非三阴性乳腺癌的病灶形态(P=0.035)、肿块边缘(P<0.001)、内部强化特点(P<0.001)及T2WI信号(P<0.001)差异有统计学意义,三阴性乳腺癌更多表现为肿块样强化、边缘光滑、环形强化及T2WI上高亮信号。其中边缘、内部强化特点进入回归模型,比值比(OR)分别为3.279和4.577。受试者工作特征曲线(ROC)证实,病灶表现为边缘光滑及环形强化的特点具有较高的诊断价值[曲线下面积(AUC)为0.812]。结论边缘光滑及呈环形强化的肿块样强化为三阴性浸润性导管癌较为特征的MRI表现。     

结节肿块型乳腺导管内乳头状瘤的MRI表现及与乳腺浸润性导管癌的鉴别诊断

目的探讨结节肿块型乳腺导管内乳头状瘤(IDP)的磁共振成像(MRI)表现及与乳腺浸润性导管癌(IDC)的鉴别诊断。方法回顾性分析2019年6-12月该院经术后病理证实的56例结节肿块型乳腺IDP患者、30例乳腺IDC患者MRI影像学特征,包括形态学、平扫信号、动态增强时间-信号强度曲线(TIC)类型、弥散加权成像(DWI)及表观扩散系数(ADC)值特点;采用无序多分类logistic模型对结节肿块型乳腺IDP的MRI影像学特征进行多因素分析。结果 56例结节肿块型乳腺IDP患者中,单纯结节肿块型乳腺IDP 41例(73.21%),结节肿块型乳腺IDP伴非典型上皮增生15例(26.79%)。结节肿块型乳腺IDP与乳腺IDC的病灶形态、大小、边缘、边界、毛刺、血管增粗、强化、ADC值及早期强化率比较,差异有统计学意义(P0.05)。结节肿块型乳腺IDP伴非典型上皮增生的MRI影像学特征介于单纯结节肿块型乳腺IDP与乳腺IDC之间。无序多分类logistic分析显示,早期强化率低、无增粗血管及无毛刺的MRI影像学特征提示为单纯结节肿块型乳腺IDP(P0.05),早期强化率低、无增粗血管的MRI影像学特征提示为结节肿块型乳腺IDP伴非典型上皮增生(P0.05)。结论 MRI表现有助于结节肿块型乳腺IDP与乳腺IDC的鉴别诊断。     

94例不同病理类型乳腺癌的3.0T MRI表现

目的 分析不同病理类型乳腺癌的3.0T MRI特征. 方法 回顾性分析经手术病理证实的94例乳腺癌患者资料,分析不同病理类型乳腺癌的形态、强化方式及时间-强度曲线(TIC)等MR影像特征. 结果 94例乳腺癌包括11例导管原位癌、5例浸润性导管癌Ⅰ级、44例浸润性导管癌Ⅱ级、20例浸润性导管癌Ⅲ级及14例其他病理类型.导管原位癌全部为均匀强化,72.73%(8/11)病灶形态为沿导管、小叶分布的多发结节状、片状;浸润性导管癌Ⅰ级病灶TIC 80.00%(4/5)为速升缓降型,60.00%(3/5)为分叶状,60.00%(3/5)均匀强化;72.73%(32/44)浸润性导管癌Ⅱ级病灶表现为分叶状及分叶状带毛刺,63.64%(28/44)为均匀强化,TIC 59.09%(26/44)为速升缓降型、22.73%(10/44)为速升平台型;90.00%(18/20)浸润性导管癌Ⅲ级病灶表现为分叶状和不规则形,80.00%(16/20)为均匀强化和边缘强化为主, TIC 50.00%(10/20)为速升缓降型、40.00%(8/20)为速升平台、速升缓降混合型. 结论 乳腺癌的MRI表现复杂多样,但不同病理类型的乳腺癌MRI表现有一定的特征性.     

乳腺浸润性导管癌的3.0TMRI诊断

目的探讨乳腺浸润性导管癌的3.0T MR影像学特点,提高对浸润性导管癌术前诊断的准确性。材料与方法回顾性分析65例（69病灶）经手术或穿刺病理证实的浸润性导管癌患者的MRI资料,均采用3.0T MRI行平扫、动态增强及DWI序列扫描,分析病灶的MRI影像学特征,包括形态学表现、血流动力学特征、时间-信号曲线（TIC）及ADC值。采用配对设计t检验比较浸润性导管癌病灶和正常乳腺组织ADC值的差异,同时采用成组设计方差分析比较3型曲线间ADC值有无差异。结果 65例（69例病灶）浸润性导管癌表现为肿块型[58.0%（40/69）]或非肿块型[42.0%（29/69）],边缘不规则,T1WI呈等[36.2%（25/69）]或低信号[63.8%（44/69）],T2WI呈稍高[27.5%（19/69）]或高信号[72.5%（50/69）],DWI呈稍高[49.3%（34/69）]或高信号[50.7%（35/69）],增强扫描肿块型呈早期不均匀强化,内部间隔强化,非肿块型以导管样及簇集状强化为主,TIC以Ⅱ型[56.5%（39/69）]、Ⅲ型[37.7%（26/69）]曲线为主,ADC平均值（0.93±0.21）×10^-3mm^2/s,尚不能认为3型曲线间ADC值差异有统计学意义（F=0.182,P=0.834〉0.05）。结论应用3.0T MRI动态增强扫描及DWI序列,能较好的显示病变形态及强化方式,结合形态学表现、血流动力学及功能学特征,有助于对浸润性导管癌的术前诊断。     

肝脏外周型胆管细胞癌的MRI诊断

目的:探讨肝脏外周型胆管细胞癌的MRI表现及其诊断价值。材料与方法:回顾性分析15例经手术及病理证实的胆管细胞癌的MRI表现特点,并与病理对照。结果:15例周围型肝内胆管细胞癌MRI主要表现为不规则浸润性肿块,其中11例病变位于肝左叶区,4例位于肝右叶。15例病变于T1WI均呈低信号,13例于T2WI呈不均质性高信号,2例于T2WI呈较均质性略高信号。增强扫描显示早期病灶强化不明显,或肿瘤边缘及肿瘤实质部分轻微强化,门脉期和延迟扫描肿瘤进一步强化。结论:外周型胆管细胞癌的MRI表现有一定特点,动态增强扫描是诊断的关键技术,早期边缘强化、延迟后肿瘤进一步强化是其影像诊断重要依据。     

乳腺导管原位癌的影像学表现及与病理分级的关系

目的评估乳腺导管原位癌(DCIS)的MRI形态学及动态增强表现,提高对DCIS的认识,并进一步分析MRI表现与组织学核级别是否具有相关性。方法回顾性分析22例经病理证实为DCIS患者的MRI表现,研究其MRI形态学特点及动态增强表现,并分析MRI特点与组织学核级别的相关性。结果 22例患者中,非肿块样强化14例(段样强化9例,其内部均表现为轨道样或簇状小环样强化;区域性强化4例;线样强化1例),肿块样强化8例,均有恶性肿瘤征象,如分叶、毛刺、不均匀强化等。动态增强表现:Ⅰ型曲线5例、Ⅱ型曲线12例、Ⅲ型曲线5例;早期强化率包括早期缓慢强化2例、早期中度强化8例、早期快速强化12例。早期强化率及病灶大小与组织学核级别显著相关,P值分别为0.031和0.002;动态增强曲线类型和形态学表现与组织学核级别无相关性,P值分别为0.4和0.225。结论乳腺DCIS的MRI表现具有相对特异性,结合形态学及血流动力学,可较全面评价DCIS组织学核级别程度,对临床具有重要的指导意义。     

钼靶和MR诊断乳腺纯黏液腺癌

目的 探讨乳腺纯黏液腺癌钼靶及MRI影像学特征。方法 回顾性分析25例经手术病理证实为乳腺纯黏液腺癌患者的资料,11例接受MR检查,17例接受钼靶检查,其中3例同时接受MR及钼靶检查。结果 17例纯黏液腺癌钼靶表现包括：肿块10例,肿块伴微钙化3例,不对称影1例,不对称影伴微钙化2例,钼靶阴性1例。13例以肿块（或伴钙化）为表现的病灶中,6例为高密度,7例为等密度。11例纯黏液腺癌MRI表现包括：9例病灶呈肿块样强化,其中8例呈边缘环形强化,1例早期不均匀强化、晚期均匀强化;2例呈非肿块样强化,均呈段样分布;所有病灶动态增强曲线均为流入型,TIRM及T2-FS序列均为高信号或等高混杂信号。结论 乳腺纯黏液腺癌钼靶多表现为等密度肿块,MRI长TE序列高信号及动态增强序列边缘环形强化较具特征性。     

不同年龄组肿块型乳腺浸润性导管癌的增强MRI影像特征

目的探讨不同年龄肿块型乳腺浸润性导管癌的MRI的影像表现。材料与方法回顾性分析陆军总医院经病理学证实的乳腺浸润性导管癌术前MRI影像表现,将肿块型强化患者纳入研究。分析肿块型乳腺癌的发病位置、形态特征及强化方式。结果入组患者共65例,青年组18例,中老年组47例。青年组(≤40岁)表现边界不清楚的9例,占50%,中老年组(40岁)边界不清者9例,占19.1%,两者差别具有统计学意义(P0.05)。两组之间病理分级、大小、形状、边缘是否分叶及毛刺、TIC类型均无显著性差异(P0.05)。结论青年肿块型乳腺浸润性导管癌表现为边界不清者比例高于中老年患者,可能提示其具有更强的侵袭性及转移能力,预后较差。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.