骶骨发育不全的研究进展

骶骨发育不全是一种罕见但严重的骶骨发育异常性先天畸形。该病常在骶骨部分或全部缺如的基础上,合并脊柱脊髓、神经根、泌尿系统、直肠肛门、下肢等多器官畸形,尤其是畸形不断进展的病例,对患者的生活质量影响巨大,临床处理也极为困难。虽然近年来关于骶骨发育不全的文献报道逐渐增多,但该病在病因等很多方面尚不明确,治疗也存在较大争议。故本文结合近年来国内外文献对骶骨发育不全的病因、危险因素、临床表现、诊断、分型、治疗现状及最新进展做一综述。     

手术治疗骶骨发育不全合并脊柱骨盆分离1例报告

正骶骨发育不全是一种罕见的先天性疾病,影像学表现为骶骨畸形,临床主要表现为脊柱骨盆不稳或明显的脊柱骨盆分离,骶骨缺损侧半侧骨盆出现漂浮,同时可伴有脊柱旋转侧凸畸形,行走困难或跛行。手术治疗旨在阻止畸形继续发展,改善患者行走功能。但是由于发育不全骶骨与髂骨的缺损处较大,骨皮质大量缺乏,植骨量需求较     

产前超声检测胎儿胸腺

产前超声检测胎儿胸腺对诊断胎儿胸腺发育异常及相关畸形或疾病有重要作用,新技术的发展和应用可更全面地评估胎儿胸腺的发育。本文对胎儿胸腺超声检测技术及临床应用进行综述。     

超声研究胎儿胰腺发育的现状

胰腺异常属罕见先天性畸形,环状胰腺胎儿常伴发多种畸形,病死率高且预后差,产前超声早期诊断对降低围生期死亡率具有重要意义。由于胎儿胰腺位置隐蔽且体积小,在产前超声检查中常易被忽视。近年来,随着产前超声检查技术不断进步及产科检查需求更加全面、细致,利用产前超声观察胎儿胰腺大小、形态及回声越来越受到关注。本文主要对胰腺的胚胎发育、胎儿胰腺的解剖学基础及超声检查研究等进展进行综述。     

胎儿肾积水的超声诊断、干预及预后评价的研究现状

超声技术的不断发展,产前胎儿肾积水检出率增加,尚无统一诊断标准,其病因复杂,可因生理或病理的改变引起,积水程度不同,预后不同.目前.胎儿手术只考虑有严重羊水过少并且无肾脏畸形的胎儿.本文通过对胎儿肾积水的产前诊断、发病原因及机理、宫内治疗、产后处理及预后等方面的研究分析.为临床指导提供理论依据.     

胎儿肾积水的超声诊断、干预及预后评价的研究现状

超声技术的不断发展,产前胎儿肾积水检出率增加,尚无统一诊断标准,其病因复杂,可因生理或病理的改变引起,积水程度不同,预后不同.目前.胎儿手术只考虑有严重羊水过少并且无肾脏畸形的胎儿.本文通过对胎儿肾积水的产前诊断、发病原因及机理、宫内治疗、产后处理及预后等方面的研究分析.为临床指导提供理论依据.     

胎儿肾积水的超声诊断、干预及预后评价的研究现状

超声技术的不断发展,产前胎儿肾积水检出率增加,尚无统一诊断标准,其病因复杂,可因生理或病理的改变引起,积水程度不同,预后不同.目前.胎儿手术只考虑有严重羊水过少并且无肾脏畸形的胎儿.本文通过对胎儿肾积水的产前诊断、发病原因及机理、宫内治疗、产后处理及预后等方面的研究分析.为临床指导提供理论依据.     

产前超声胎儿畸形筛查及产后超声随访的应用研究

目的研究产前超声畸形筛查及产后超声随访在非产前诊断医院中的应用。方法回顾性分析笔者所在医院2008~2011年诊断为胎儿畸形的资料,对比2006~2008年检出畸形胎儿的资料,对检出的数量及结构进行比较。结果阻止畸形胎儿出生数,检出畸形的种类均明显高于开展产前系统超声检查前,开展产后超声随访有效的避免医疗纠纷的发生。结论在非产前诊断医院,特别是县市级医院合理开展系统超声胎儿畸形筛查能对优生优育起到很大的促进作用。     

胎儿主动脉弓离断的产前超声诊断现状

主动脉弓离断是一种罕见的严重先天性心脏病,胎儿期死亡率极高,其胚胎学起源复杂,表现形式多样,且多合并其他畸形,产前超声诊断困难。超声心动图作为目前临床常用的胎儿心脏检查手段,在先天性心脏病的筛查中发挥重要作用。本文主要从二维超声、三维超声在诊断中的应用及超声鉴别诊断方面对胎儿主动脉弓离断的产前超声诊断现状进行综述。     

彩色多普勒超声在高龄孕妇中对泌尿系统畸形胎儿的产前诊断价值分析

目的 分析不同类型泌尿系统畸形胎儿的彩色多普勒超声声像图的特征,评价彩色多普勒超声对高龄孕妇在产前诊断泌尿系统畸形胎儿的临床研究和诊断价值.方法 随机选择2014年3月至2016年2月本院接收的1 642例平均年龄为35.2岁且孕周为14~38周的孕妇,进行彩色多普勒常规检查,同时观测孕妇腹中胎儿的健康状况,收集对孕妇以及胎儿的临床资料和彩色多普勒超声声像特征并进行统计分析,并对怀疑为泌尿系统畸形的胎儿进行随访验证.对检测出泌尿系统畸形胎儿、疑似泌尿系统畸形胎儿和漏诊的病例,在分娩后进行彩色多普勒超声诊断和随访,将随访的结果与产前彩色多普勒超声检查的统计结果相对照.结果 通过彩色多普勒超声检测1 642例孕妇,对其超声声像特征的资料进行分析,根据超声声像图特征做出诊断.检测发现有42例泌尿系统畸形的胎儿,包含肾发育不良胎儿4例,占9.5%;多囊性发育不良8例,占19.04%;肾盂扩张15例,占35.7%;肾积水6例,占14.3%;肾缺如7例,占16.7%;巨膀胱1例,占2.4%;尿道下裂1例,占2.4%;进行产前彩色多普勒超声检测的诊断结果与分娩后检查和随访结果一致,其中一例被误诊,产妇分娩后病症消失.结论 产前对高龄孕妇进行彩色多普勒超声检查,诊断出泌尿系统畸形胎儿的准确率较高.利用彩色多普勒超声检测,使得泌尿系统畸形胎儿在产前即可作出诊断,为临床诊断、采取措施和预后评估提供了可靠且重要的依据.     

金黄色葡萄球菌和表皮葡萄球菌体外对人精子运动功能的影响

目的 :研究金黄色葡萄球菌 (SA)和表皮葡萄球菌 (SE)体外对人精子的运动功能有无直接影响。　方法 :将泌尿生殖系感染病人中分离培养的SA和SE制成活菌悬液 ,体外与 10例健康成年男性手淫获得并经上游优化处理的精子孵育。按细菌 /精子比 5 0∶1分别孵育 0、2、4h后 ,采用计算机辅助的精子分析系统检测人精子活率、运动参数 (前向性运动百分率、直线速度、曲线速度、平均路径速度 )和精子形态及凝集情况。　结果 :SA与精子体外孵育 2、4h后 ,精子活率和运动参数明显降低 (P <0 .0 5 )。SE体外对精子的活率和运动功能则无明显影响。　结论 :SA与精子的比例为 5 0∶1,体外孵育 2h后 ,能显著降低精子活率和抑制精子运动功能。SE对精子运动功能无直接影响。     

Serum albumin level during intestinal exfoliative rejection: a potential predictor of graft recovery and patient outcome

Exfoliative rejection is a severe complication after intestinal transplant. The assessment of mucosa histology is restricted to the area reached by endoscopy. We aim to evaluate the serum albumin (SA) value as a parameter of graft damage and clinical prognosis in intestinal exfoliative rejection (ExR). The present study is a retrospective analysis of 11 episodes of ExR occurred in a cohort of 26 patients. SA levels were measured 24 h after diagnosis and twice a week thereafter and then correlated with parameters of clinical and graft histological recovery (HR). During ExR, all patients had very low SA levels, reaching a minimum average of 1.9 ± 0.3 g/dL. According to the value of albumin levels at ExR diagnosis, the patients were grouped finding a correlation with their clinical evolution. Six ExR episodes presented with severe hipoalbuminemia (<2.2 g/dL; p < 0.05) that correlated with worse patient and graft outcome, ranging from graft loss and need for re‐transplantation to delayed clinical and HR. SA at ExR diagnosis may be an indicator of the severity of the ExR process, and it could also be used as an early predictor of patient and graft outcome.     

Inflammation of the residual appendix stump: a systematic review

Aim A systematic review of the literature was undertaken to examine reported cases of stump appendicitis (SA) to determine the relationship between SA and the original operative strategy (open vs laparoscopic), and to evaluate the clinical features and diagnosis. Method A Pub‐med search was conducted to identify cases of appendicitis of a residual stump following appendicectomy. Two original cases of SA following laparoscopic appendicectomy treated in our own hospitals are also included in the analysis. Sixty cases of SA reported in the English medical literature were analysed. Results The interval from the original appendicectomy ranged from 4 days to 50 years. SA followed appendicectomy in 58% of open and 31.6% of laparoscopic procedures. SA was frequently misdiagnosed as constipation or gastroenteritis, with a significant delay to surgery. Computerized tomography diagnosed SA in 46.6% of cases. Perforation with gangrene of the stump occurred in 40%. Conclusion Stump appendicitis is rare. It may complicate open or laparoscopic appendicectomy. A high level of suspicion should be maintained in any patient with right sided abdominal pain and a history of prior appendicectomy.     

Review article: Managing sleep apnoea in kidney diseases

A higher prevalence of sleep apnoea (SA) has been observed in the chronic kidney disease (CKD) population compared with estimates in the general population. Increased rates of SA have been described in patients with various renal‐related diagnoses including dialysis, renal transplant, early‐stage CKD and proteinuria. The mechanism or underlying aetiology for this association is different for each type of kidney disease. The extracellular fluid volume and metabolic derangements that characterize the uremic state likely contributes to SA in the dialysis population. SA causing direct renal insults from haemodynamic changes, ischaemic stress, or an intermediary condition such as hypertension, can lead to early CKD and proteinuria. While renal transplantation has cured SA in some patients, the post‐transplant state is itself a risk factor for SA. The high prevalence of SA in kidney disease and the associated clinical implications warrant vigilance in diagnosis and treatment of SA in the CKD patient. This review focuses on the prevalence of SA in patients with CKD including dialysis and transplant patients, and those with early‐stage CKD and proteinuria. SA may vary in form and aetiology depending on type or stage of CKD. Based on these associations, we discuss our rationale for recommendations on screening and management of SA specific to the CKD population.     

超声多普勒在体表血管畸形诊治中的应用

探讨超声多普勒在体表血管畸形诊治中的作用。采用多普勒血流仪ＤＵＦ（Ｄｏｐｐｌｅｒｕｌｔｒａｓｏｎｉｃｆｌｏｗｍｅｔｅｒ）并结合彩色多普勒血流成像ＣＤＦＩ（Ｃｏｌｏｒｄｏｐｐｌｅｒｆｌｏｗｉｍａｇｉｎｇ）、血管造影ＳＡ（Ｓｅｌｅｃｔｉｖｅａｎｇｉｏｇｒａｐｈ）、术后组织学检查作自身对照２８例、３７个瘤体及ＤＵＦ术中应用１２例。ＤＵＦ对体表部位的高或低流量性病损的定性诊断与上述三种检查基本相符,其还能指导选择性结扎瘤体内的血管及术中避免损伤体表知名动脉,但不能提示病损结构和范围;ＣＤＦＩ除能提供病损区动、静脉血流信号外,尚可提示深部（肌层）病损情况,但不能显示病损的完整结构;ＳＡ既能提示病损的血流情况,也能显示病损大小和范围。总之,ＤＵＦ结合临床可初步明确体表血管畸形的高或低流量性病损,该方面诊断ＣＤＦＩ更为精确,ＣＤＦＩ与ＳＡ结合对血管异常的诊断和治疗是必要的。     

National primary care guidelines for England: impact on chronic kidney disease prevention in South Asian populations

Introduction: This study evaluated the impact of national policy for kidney disease in primary care comparing South Asian (SA) and white European (WE) population groups. Methods: Retrospective audits of primary care records of SA and WE adults diagnosed with diabetes in 2004 and 2007 were carried out in a total sample of 707 patients across 18 general practices within Luton, Leicester and West London. Results: Four hundred patients (SA: n=241, and WE: n=159) were diagnosed as diabetic in 2004, and 307 (SA: n=178, and WE: n=129) in 2007. South Asian patients were 9-10 years younger, had lower systolic blood pressure than white Europeans at diagnosis in both years (136.1 vs. 141.4 mm Hg, p=0.01, in 2004; and 134 vs. 142.3 mm Hg, p=0.000, in 2007) and significantly higher HbA1c (8.6%, 63 mmol/L vs. 7.9%, 71 mmol/L) at diagnosis in 2004 than in 2007 (8.3%, 67 mmol/L vs. 8.2%, 66 mmol/L). Recording of the majority of variables associated with diabetic kidney disease increased across both patient groups between 2004 and 2007: albumin to creatinine ratio (up 13.0% in SA to 37.9%, and 15.1% in WE to 40.3%), estimated glomerular filtration rate (up 61.7% in SA to 70.8% and 75.6% in WE to 80.6%) and proteinuria (up 19.3% in SA to 46.3% and 26.1% in WE to 51.9%). Conclusions: Recording of indicators for diabetic kidney disease at diagnosis increased in both South Asians and white Europeans following introduction of national guidance to improve early detection and quality of care in the diabetic kidney disease care pathway.     

Criteria of diagnosis and grading of oligodendrogliomas or oligo-astrocytomas according to the WHO and Sainte-Anne classifications

Two main classification systems are used in France for the histological typing and grading of oligodendrogliomas: the WHO and Sainte-Anne Hospital (SA) classifications. According to the WHO, the typing of diffuse gliomas is based on the predominant cell type, oligodendroglial versus astrocytic. In contrast, the SA classification is based on the distinction of two patterns of tumor growth, solid tumor tissue versus isolated tumor cells and also relies on imaging and clinical features. According to this approach, the SA classification includes in the category of oligodendrogliomas, the fibrillary or gemistocytic diffuse astrocytomas (WHO grade II) as well as a substantial proportion of astrocytomas WHO grade III, 2) the WHO uses multiple histological criteria for the grading of oligodendrogliomas (grade II versus grade III), including the degree of differentiation, cellular atypia, mitotic activity and necrosis. In contrast, the SA grading of these tumors (grade A versus B) only uses two criteria: the presence or absence of endothelial hyperplasia, and the presence or absence of contrast enhancement. This last criterion allows overcoming the problems related to the representativeness of surgical samples. Difficulties and discrepancies regarding the diagnosis of oligodendrogliomas are in part due to the lack of immunomarker for the identification of tumoral oligodendrocytes. The potential interest of new markers of oligodendroglial precursors for the diagnosis of these tumors will further be discussed.     

Non-Hodgkin's lymphoma as an unexpected diagnosis in a shoulder arthroplasty

Shoulder arthroplasty (SA) is commonly performed in patients with rheumatoid arthritis (RA) who have been treated with long-term immunosuppressive medication. RA is associated with an increased risk of neoplasms of the immune system. A case of non-Hodgkin's lymphoma as an unexpected diagnosis after the routine pathologic examination of the soft tissues after SA was detected in a 54-year-old woman with long-standing RA and prolonged immunosuppressive therapy. Although this case does not support the cost-effectiveness of routine specimen evaluation during SA, we suggest that histological analysis of the surgical tissues is appropriate and should be performed in all patients who have been treated with prolonged immunosuppressive medication, especially RA patients as well as patients who have suspicious surgical findings.     

Syringomatous adenoma of the nipple

Infiltrating syringomatous adenoma (SA) of the nipple is a rare but distinct benign clinical entity affecting the breast. It needs to be included in the differential diagnosis of patients who present with a lump in the nipple/areola complex. It is similar histologically to a syringoma, a benign tumour originating in the ducts of the dermal sweat glands, and importantly needs to be distinguished from a tubular carcinoma. SA of the nipple is locally infiltrating but is not known to metastasise. It often presents as a subareolar lesion with clinical, mammographic and ultrasound findings suspicious for malignancy. Whilst it may be possible to suspect the diagnosis on fine needle cytology, core biopsy or excisional biopsy is usually required to establish the diagnosis. There is a tendency to recurrence if excision is incomplete. The following is a case report, literature review and discussion of the surgical management options available in this unusual condition.     

Accuracy of helical computed tomography for the identification of lymph node metastasis in resectable non-small cell lung cancer

Purpose  The criteria for the diagnosis of lymph node metastasis (LNM) in non-small cell lung cancer were investigated using helical computed tomography (hCT). The conventional criterion (1-cm short axis threshold) is generally accepted; however, this criterion is based on conventional CT. New criteria for LNM were investigated because the resolution of hCT is better than that of conventional CT. Methods  Ninety-seven NSCLC patients examined with hCT were enrolled. Both the long axis (LA) and short axis (SA) of the nodes were measured using hCT. Results  Based on the receiver operating characteristic curves, the thresholds that gave optimal sensitivity and specificity for LNM were 13 mm for LA and 9 mm for SA. The LNM diagnosis was re-evaluated using the combination of cutoff values. When the LA was ≥13 mm and the SA was ≥9 mm, the sensitivity, specificity, and accuracy were 56.3%, 92.1%, and 88.1%, respectively. When the LA was ≥13 mm or SA was ≥9 mm, sensitivity, specificity, and accuracy were 75.0%, 74.7%, and 74.7%, respectively. These values were not so different from the conventional criterion recalculated from these data. Conclusion  The new criteria are considered to be useful for making a LNM diagnosis. The conventional criteria for the LNM diagnosis might therefore be applicable even for hCT.