孤立性纤维瘤的影像学分析

目的：探讨多部位孤立性纤维瘤（solitary fibrous tumors,SFT）的影像学表现,提高对该疾病的诊断与鉴别诊断水平。方法回顾性分析10例经手术病理证实为SFT的CT/MR及手术病理资料。其中8例患者均行螺旋CT平扫并增强、多平面重建（MPR）、冠状、矢状重建,2例CT平扫及MRI平扫并增强。分析获取图像,探讨SFT的CT/MR表现。结果8例位于胸膜腔内,1例骑跨胸腹部后纵隔,1例位于上颈部及颅内,形成勾通性肿块。胸膜来源的SFT常以宽基底附于胸膜,肿瘤与正常胸膜间夹角常为钝角,肿块较小（小于10 cm）推压肺组织,与肺组织尚可分界;肿块较大（大于或等于10 cm）时,与肺组织分界较模糊,提示有侵犯可能;胸膜来源的SFT的CT平扫表现为均匀或略不均匀软组织肿块,增强扫描病灶表现为不均匀强化,呈地图样强化,病灶较大时可见不规则坏死区。胸膜外（纵隔、头颈部）SFT表现为巨大软组织肿块,生长较缓慢,常生长于相对薄弱间隙内,推压或侵犯邻近器官。MRI平扫T1WI为等信号,T2WI为不均匀高信号,FS-T2WI呈不均匀混杂高信号,DWI呈低信号,增强扫描病灶明显不均匀强化,周缘强化略明显。结论 SFT好发于胸膜腔内,表现为孤立的软组织肿块,宽基底、界线较清楚、邻近肺组织受推压、血供丰富,无肺门、纵隔、腋窝淋巴结肿大;纵隔及头颈部可为胸膜外SFT的发病部位,肿块生长于肌间隙或薄弱间隙,血供丰富,明显强化。病灶大于10 cm、强化不均匀（伴坏死）、侵犯周围组织提示恶性可能。     

Bedside ultrasound as a predictive tool for acute chest syndrome in sickle cell patients

Background

Acute chest syndrome (ACS) is the leading cause of death for patients with sickle cell disease (SCD). Early recognition of ACS improves prognosis.

Visualization of the inferoposterior thoracic wall (VIP) and boomerang signs-novel sonographic signs of right pleural effusion

Objectives

This study is to present the diagnostic values of the novel sonographic visualization of the inferoposterior thoracic wall (VIP) and boomerang signs in detecting right pleural effusion by sonologists with little to no experience in ultrasound.

联合检测CRP、D-二聚体和CEA在诊断胸腔积液性质中的意义

目的探讨联合检测C反应蛋白(CRP)、D-二聚体和癌胚抗原(CEA)在诊断胸腔积液性质中的意义。方法收集76例恶性胸腔积液患者(试验组)和58例结核性胸腔积液患者(对照组)的胸腔积液标本,检测胸腔积液中CRP、D-二聚体和CEA的数值,并进行统计学分析。结果试验组D-二聚体和CEA的阳性率显著高于对照组,差异有统计学意义(P<0.05或P<0.01),而CRP含量却显著低于对照组,差异有统计学意义(P<0.01)。结论 CRP、D-二聚体和CEA的联合检测可提高对胸腔积液性质诊断的准确性。     

Electrolyte analysis of pleural effusion for discrimination between seawater and freshwater drowning in decomposed bodies

ObjectiveThe diagnosis of drowning is an important issue in forensic investigations. Moreover, discriminating between seawater and freshwater drowning is crucial to identify where the drowning occurred. The present study aimed to investigate electrolyte concentrations in pleural fluid in decomposed bodies in late postmortem intervals and derive cut-off values for the diagnosis of seawater and freshwater drowning.Study designData were collected from 44 seawater drowning cases, 60 freshwater drowning cases, and 30 non-drowning cases with pleural effusion which served as controls. The levels of sodium ion (Na⁺), potassium ion (K⁺), and chloride ion (Cl⁻) of pleural fluid were measured, and two indices were calculated: summation of Na⁺ and K⁺ levels (SUM _Na + K), and summation of Na⁺, K⁺, and Cl⁻ levels (SUM _{Na + K + Cl}). The means of the three ion concentrations and two indices significantly differed between the three groups (p < 0.0001).ResultsThe receiver operating characteristic analysis revealed that the sensitivity and specificity were both 1.000 for SUM _{Na + K + Cl} of 288.3 mEq/L between the seawater and control groups. The Na⁺ value of 109.0 mEq/L also had a high sensitivity of 0.977 and a specificity of 0.933 in the seawater and control groups. The sensitivity and specificity were 0.967 and 1.000, respectively, for SUM _Na + K of 123.2 mEq/L between the freshwater and control groups.ConclusionThe electrolyte concentrations in pleural effusion may be useful for the diagnosis of drowning in decomposed bodies with a longer postmortem interval.     

Assay of pleural fluid interleukin-6, tumour necrosis factor-alpha and interferon-gamma in the diagnosis and outcome correlation of tuberculous effusion

OBJECTIVE: To assess the usefulness of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) in the diagnosis and prediction of outcome of pleural tuberculosis. PATIENTS AND METHODS: Pleural fluid from 32 TB and 34 non-TB patients was sent for assay of IL-6, TNF-alpha and IFN-gamma. Clinical parameters at presentation and residual pleural scarring at completion of treatment were assessed for pleural TB cases. RESULTS: The pleural fluid Levels of IL-6, TNF-alpha and IFN-gamma in TB patients were significantly higher than those with non-TB effusions (P values of <0.001, 0.018 and <0.001, respectively by independent t-test). Utility of these cytokines for diagnosis of pleural TB was evaluated using receiver operating characteristic (ROC) curve analysis. The cut-off values for IL-6, TNF-alpha and IFN-gamma determined in this analysis were 4000, 4 and 60 pg/ml respectively, and their sensitivity and specificity were 90.6% and 76.5%, 90.6% and 79.4%, 100% and 100%, respectively. The pretreatment pleural fluid IL-6 levels had a positive correlation with the number of febrile days after treatment (Pearson correlation test: r=0.60, P=0.009). A negative correlation was found between the percentage reduction in pleural fluid cytokines after 2 weeks treatment and the extent of residual pleural scarring (IL-6: r=-0.62, P=0.041; TNF-alpha: r=-0.65, P=0.030; IFN-gamma: r=0.83, P=0.002). CONCLUSION: Pleural fluid IL-6, TNF-alpha and IFN-gamma assays are useful in the diagnosis of pleural TB. The initial IL-6 level correlates with the number of febrile days. The percentage change of cytokines after 2 weeks of treatment also helps to predict residual pleural scarring.     

内科胸腔镜检术在不明原因胸腔积液中的应用分析

目的：探讨胸腔镜检查术对不明原因胸腔积液的诊断价值。方法：85例不明原因的胸腔积液患者行胸腔镜检术,取病变组织行病理检查。结果：镜下表现可以分为5种,分别是乳白色、鲜红色弥漫性粟粒样结节38例(44．7%),单发或多发菜花样、乳突状结节34例(40%),胸膜充血、水肿6例(7．1%),胸膜增厚及纤维分隔或粘连带形成4例(4．7%),无明显异常3例(3．5%)。胸腔镜检术确诊率91．7%。确诊病例中恶性肿瘤32例(37．6%),其中肺癌转移24例(腺癌20例,鳞癌3例,小细胞肺癌1例),恶性胸膜间皮瘤2例,胃癌胸膜转移3例,肝癌2例,淋巴瘤1例。良性疾病共50例(58．8%),其中结核性胸膜炎46例(54．1%),慢性炎症4例(4．7%)。无严重并发症。结论：胸腔镜检查术对不明原因的胸腔积液是一种安全、确诊率高的诊断方法。     

胸水结核抗体对结核性胸膜炎的诊断意义

目的 了解结核性胸膜炎的诊断意义。方法 检查205例胸水的病因分析。结果 胸水结核抗体对结核性胸膜炎阳性率最高83.1%。结论 胸水结核抗体对鉴别结核性胸膜炎有较高实用价值。     

CD13/aminopeptidase N in collagen vascular diseases

To determine the significance of CD13/aminopeptidase N in collagen vascular diseases (CVD), we examined its activity and expression in sera and disease sites of patients with CVD. Significantly higher aminopeptidase activity was detected in bronchoalveolar lavage fluid from patients with interstitial lung diseases due to rheumatoid arthritis (RA), polymyositis/dermatomyositis (PM/DM), systemic sclerosis (SSc), and Sjögren's syndrome than from control subjects. Increased aminopeptidase activity and increased expression of CD13/aminopeptidase N protein were found in alveolar macrophages from CVD patients with interstitial lung diseases. Significantly higher aminopeptidase activity was detected in pleural effusions from patients with systemic lupus erythematosus (SLE) than in transudate effusions. The mean aminopeptidase activity in synovial fluids from RA patients was significantly higher than from patients with osteoarthritis. The mean value of serum aminopeptidase activity was significantly higher in patients with SLE, RA, SSc, and PM/DM than in normal subjects. This study suggests that the activity of CD13/aminopeptidase N, locally produced in the disease site, is a useful marker for CVD and that CD13/aminopeptidase N may have an important role in the pathogenesis of CVD.