食道鳞状上皮乳头状瘤23例报告并文献复习

目的：探讨食道鳞状上皮乳头状瘤与食道癌癌前病变的关系。方法：回顾性分析23例食道鳞状上皮乳头状瘤的内镜表现及12例5年追踪随访资料。结果：食道鳞状上皮乳头状瘤是一种罕见的良性肿瘤。结论：食道鳞状上皮乳头状瘤似乎不能作为食道癌的癌前病变，与人类乳头状瘤病毒感染无关，是否具有潜在的恶性损害有待进一步研究。     

Comparison of double inversion recovery magnetic resonance imaging (DIR-MRI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in detection of prostate cancer: A pilot study

IntroductionDCE-MRI is established for detecting prostate cancer (PCa). However, it requires a gadolinium contrast agent, with potential risks for patients. The application of DIR-MRI is simple and may allow cancer detection without the use of an intravenous contrast agent by differentially nullifying signal from normal and abnormal prostate tissue, creating contrast between the cancer and background normal prostate. In this pilot study we gathered data from DIR-MRI and DCE-MRI of the prostate for an equivalence trial. We also looked at how the DIR-MRI appearance varies with the aggressiveness of PCa.MethodDIR-MRI and DCE-MRI were acquired. The images were assessed by an experienced Consultant Radiologist and a novice reporter (Radiographer). The potential PCa lesions were quantified using a lesion to normal ratio (LNR). Radiological pathological correlation was made to identify the MRI lesions that represented significant PCa. A Wilcoxon sign rank was used to compare DCE-LNR and DIR-LNR for PCa containing lesions. Pearson's correlation was used to look at the relationship between DIR-LNR and PCa grade group (aggressiveness).ResultsDCE-LNR and DIR-LNR were found to be significantly different (Z = −5.910, p < 0.001). However, a significant correlation was found between PCa grade group and DIR-LNR.ConclusionDIR and DCE sequences are not equivalent and significant cancer is more conspicuous on the DCE sequence. However, DIR-LNR does correlate with PCa aggressiveness.Implications for practiceWith the correlation of PCa grade group with DIR-LNR this may be a useful sequence in evaluation of the prostate; stratifying the risk of there being clinically significant PCa before biopsy is performed. Furthermore, given that DIR-LNR appears to predict PCa aggressiveness DIR might be used as part of a multiparametric MRI protocol designed to avoid biopsy.     

CT-guided biopsy of lung lesions: defining the best needle option for a specific diagnosis

OBJECTIVES:

To evaluate the performance of fine and cutting needles in computed tomography guided-biopsy of lung lesions suspicious for malignancy and to determine which technique is the best option for a specific diagnosis.

METHODS:

This retrospective study reviewed the data from 362 (71.6%) patients who underwent fine-needle aspiration biopsy and from 97 (19.7%) patients who underwent cutting-needle biopsy between January 2006 and December 2011. The data concerning demographic and lesion characteristics, procedures, biopsy sample adequacy, specific diagnoses, and complications were collected. The success and complication rates of both biopsy techniques were calculated.

RESULTS:

Cutting-needle biopsy yielded significantly higher percentages of adequate biopsy samples and specific diagnoses than did fine-needle aspiration biopsy (p<0.05). The sensitivity, specificity, and accuracy of cutting-needle biopsy were 93.8%, 97.3%, and 95.2%, respectively; those of fine-needle aspiration biopsy were 82.6%, 81.3%, and 81.8%, respectively (all p<0.05). The incidence of pneumothorax was higher for fine-needle aspiration biopsy, and that of hematoma was higher for cutting-needle biopsy (both p<0.05).

CONCLUSIONS:

Our experience using these two techniques for computed tomography-guided percutaneous biopsy showed that cutting-needle biopsy yielded better results than did fine-needle aspiration biopsy and that there was no significant increase in complication rates to indicate the best option for specific diagnoses.     

Pyoderma Gangrenosum Associated with Crohn Disease: Effect of TNF- α Blockade with Infliximab

Eight patients with pyoderma gangrenosum associated with Crohn disease were treated with infliximab. All had active mucosal inflammation indicated by endoscopic examination. Within 1-4 months, infliximab treatment resulted in complete healing of the pyoderma gangrenosum in 3 cases (1 parastomal, 2 lower limb), partial healing in 3 (2 parastomal, 1 lower limb) and temporary improvement in 2. Adverse effects such as skin rash, pneumonia and diarrhoea were seen in three patients. Our results imply that infliximab has a therapeutic potential on skin manifestations associated with inflammatory bowel disease, even though successful treatment may require repeat courses of infliximab infusions.     

阴道镜检查在宫颈癌前病变中的诊断价值研究

[目的]探讨阴道镜检查在诊断宫颈癌前病变中的临床诊断价值。[方法]对2001年1月～2006年12月786例宫颈病变患者的阴道镜检查结果和同期直视下行宫颈活检的患者634例进行对比性研究。[结果]慢性宫颈炎、宫颈上皮内瘤样病变和癌在阴道镜下图像均呈多样性;阴道镜检查的宫颈病变行宫颈活检术者中宫颈上皮内瘤样病变和湿疣的检出率明显高于肉眼直视下行宫颈活检者,差异有统计学意义（P﹤0.005）。炎症和癌的检出率差异无统计学意义（P﹥0.25,P﹥0.75）。[结论]阴道镜检查在对宫颈病变的癌前病变的早期诊断中具有重要价值,阴道镜下定位活检可提高宫颈病变诊断的准确性和检出率。     

高频超声在肢体外周神经病变诊断中的应用

目的 探讨高频超声在肢体外周神经病变诊断中的应用价值.方法 用高频超声检查30例正常肢体外周神经和32例肢体外周神经病变患者,其中肢体外周神经损伤25例,肢体外周神经纤维瘤3例,神经鞘膜瘤4例.结果 高频超声可以清晰显示正常外周神经声像图,高频超声对肢体外周神经病变诊断总符合率为90.6%(29/32),并总结肢体各类型外周神经损伤及神经纤维瘤,神经鞘膜瘤声像图特点.结论 高频超声可作为外周神经损伤和肿瘤首选的检查方法,对临床治疗和选择手术方案有重要指导意义,值得临床推广应用.     

Involvement of the medial temporal lobe in priming for new associations

This study was addressed to the question of whether the medial temporal lobe (MTL) plays a critical role in implicit memory for new associations. Priming for new associations was examined in two different tasks in 18 patients with focal lesions all involving the MTL. In Experiment 1, following a study phase for pairs of unrelated words, subjects performed a perceptual identification task on old, recombined, and new pairs of words presented at brief exposure durations. In contrast to control subjects, and despite a normal level of item priming, the patients failed to show superior identification of the old pairs relative to the recombined pairs, the measure of associative priming. In Experiment 2, subjects engaged in speeded naming of the print color for previously studied words presented in the original color or in a different old color, and for unstudied words. Again, in contrast to control subjects and despite a normal level of item facilitation on color naming reaction time (RT), the patients failed to show priming for recently experienced new associations between words and colors. Explicit recognition memory by the patients was abnormal in both experiments. This study records an absence of priming for new associations, in two different tasks in which the nature of the stimuli was considerably different, in a large group of patients with lesions in the MTL. Although some previous research has reported significant associative priming in other tasks for patients with MTL lesions, the present results suggest that this region is critical for forming new associations of the types assessed here.     

Growing Region Segmentation Software (GRES) for quantitative magnetic resonance imaging of multiple sclerosis: intra- and inter-observer agreement variability: a comparison with manual contouring method

Lesion area measurement in multiple sclerosis (MS) is one of the key points in evaluating the natural history and in monitoring the efficacy of treatments. This study was performed to check the intra- and inter-observer agreement variability of a locally developed Growing Region Segmentation Software (GRES), comparing them to those obtained using manual contouring (MC). From routine 1.5-T MRI study of clinically definite multiple sclerosis patients, 36 lesions seen on proton-density-weighted images (PDWI) and 36 enhancing lesion on Gd-DTPA-BMA-enhanced T1-weighted images (Gd-T1WI) were randomly chosen and were evaluated by three observers. The mean range of lesion size was 9.9-536.0 mm(2) on PDWI and 3.6-57.2 mm(2) on Gd-T1WI. The median intra- and inter-observer agreement were, respectively, 97.1 and 90.0% using GRES on PDWI, 81.0 and 70.0% using MC on PDWI, 88.8 and 80.0% using GRES on Gd-T1WI, and 85.8 and 70.0% using MC on Gd-T1WI. The intra- and inter-observer agreements were significantly greater for GRES compared with MC ( P<0.0001 and P=0.0023, respectively) for PDWI, while no difference was found between GRES an MC for Gd-T1WI. The intra-observer variability for GRES was significantly lower on both PDWI ( P=0.0001) and Gd-T1WI ( P=0.0067), whereas for MC the same result was found only for PDWI ( P=0.0147). These data indicate that GRES reduces both the intra- and the inter-observer variability in assessing the area of MS lesions on PDWI and may prove useful in multicentre studies.