甲状腺肿瘤X线造影与超声检查对比分析

本文报告了经手术病理证实的53例甲状腺肿瘤,均作了甲状腺造影和B超检查.通过比较分析,我们认为造影对确定肿瘤的良、恶性以及延伸到胸骨后的异位甲状腺肿瘤有其优越性,是一项有效的检查方法;超声则能准确地判断肿瘤的囊、实性,适合碘过敏患者的检查.两种检查各有特点,配合使用有利于对甲状腺肿瘤的诊断和治疗.     

Association of multiple liver cell adenomas with spontaneous intrahepatic portohepatic shunt

The association of multiple liver cell adenomas containing foci of focal nodular hyperplasia with a spontaneous intrahepatic portohepatic venous shunt is reported in a 13-year-old male patient. At least eight nodules less than 10 cm in diameter were recognized and proved by means of surgical resection or surgical biopsies. These lesions were heterogeneous and hypodense on precontrast computed tomographic (CT) scans, and were slightly enhanced after injection of contrast medium. At magnetic resonance (MR) imaging, the signal intensity of these nodules varied. It was either hyperintense or hypointense on T1-weighted SE images. Sonography and angiography demonstrated a portohepatic venous shunt and hepatic arterialization was observed. These findings emphasize the hypothesis that hepatic arterialization may cause the development of liver cell adenomas. Moreover, it is suggested that liver cell adenoma and focal nodular hyperplasia have a common pathogenesis.     

Diffuse peripheral odontogenic fibroma: report of 3 cases

Since peripheral odontogenic fibroma (POF) is characteristically described as a solitary lesion and no diffuse POF had been reported in the literature, our cases should be considered as extremely unusual. Three diffuse cases of POF are described of which one case was seen in association with ocular and skin lesions. The question arises whether POF should be considered as a true odontogenic tumor rather than a diffuse hamartomatous lesion caused by uncontrolled induction of the gingiva. It is also possible that such lesions could be part of a yet undescribed syndrome.     

Integrating human factors into the medical curriculum

Background  The study of human factors is a scientific discipline that deals with the interactions between human beings and the elements of a system. This is important because shortcomings in these areas, if unchecked, can result in adverse outcomes. Research into human factors in industries where safety is paramount has provided the basis of countermeasures against human error. Adverse outcomes in medicine resulting from human error exact a high cost in both patient suffering and financial outlay.
CRM training  One of the approaches used to minimise the effect of human error is to train people in a set of knowledge, skills and attitudes that underpin the domain-specific competencies for that profession. These are referred to as non-technical skills (NTS). In aviation, such an approach has been shown to be both translatable from the training environment to the workplace and effective in reducing adverse outcomes.
Discussion  Medicine has incorporated this style of training, usually centred around simulator-based courses, but as yet in a piecemeal, episodic fashion which relies on participants volunteering to attend courses. Unlike other industries there is no systematic approach to linking the content of this teaching with the more conventional range of topics. As a consequence it is difficult to assess the impact of human factors training in medicine. This is partly because very little work has been done to date in identifying the key non-technical skills required in medicine, and the overall experience of workplace based assessment is limited. Lessons from other high reliability organisations may help to address the main challenges of developing the content, integrating it into the curriculum, reinforcing the concepts in the workplace through staff development and establishing its role in summative assessment.     

免疫性血小板减少性紫癜辨证分型与血小板表面相关抗体及T淋巴细胞亚群的关系

为探讨免疫性血小板减少性紫癜（ITP）中医辨证分型与免疫机理的关系,将ITP患者中医辨证分型结合血小板相关抗体（PAIg）及T淋巴细胞亚群进行分析。发现作为本病主要抗体的PAIgG脾肾阴亏型明显高于脾虚失统型（P<0.01）;OKT₈⁺值亦显著高于脾虚失统型（P<0.05）,OKT₄⁺/OKT₈⁺比值则明显低于脾虚失统型（P<0.05）。提示脾肾阴亏型的免疫损伤程度较脾虚失统型严重。     

Asymptomatic renal abscess: Evaluation with gadolinium DTPA-enhanced MRI

Incidental detection of renal mass in a transplant patient is a diagnostic challenge. These patients are at risk for the development of neoplasms and, more commonly, infection with atypical organisms. Symptomatology may be lacking in either, and both conditions may present with similar symptoms. Magnetic resonance imaging (MRI) evaluation with gadolinium DTPA is helpful in the evaluation of asymptomatic renal mass, with enhancement effectively excluding simple and hemorrhagic cysts. Because the MRI appearances of renal cell neoplasm and renal abscess overlap, both must be considered in the differential diagnosis.     

叶内型肺隔离症致咯血的栓塞治疗

目的探讨叶内型肺隔离症患者咯血的栓塞治疗效果。方法结合文献复习，回顾性分析6例叶内型肺隔离症患者血管造影表现，并对畸形动脉行栓塞治疗。结果6例叶内型肺隔离症患者血管造影显示畸形动脉7支，表现为粗大、迂曲的体循环血管影；在毛细血管期可见隔离肺叶染色及引流静脉早显；静脉期显示引流静脉（肺静脉）。6例患者均进行畸形血管栓塞治疗，临床止血总有效率100％，随访1a均未复发。结论畸形血管栓塞术对叶内型肺隔离症致咯血的治疗，安全有效。     

Integrinα4在骨肉瘤中的表达与意义

Objective： To investigate the expression of integrin α4 in osteosaxcoma and significance. Methods- Forty-six patients with osteosarcoma （Enneking Ⅰ-Ⅲ） were analyzed for the expression of α4 integrin subunit using immunohistochemical method. Results： Twenty-nine （63.04%） of 46 samples demonstrated positive （＋-＋＋） integrin α4 expression. Loss expression of integrin α4 was observed in the patients with advanced Enneking stage （P=0.0040） and with metastatic disease at presentation （P=0.0158）. Integrin α4 expression correlated with cell differentiation, the level of malignancy and the invasive behavior of osteosaxcoma. Conclusion： The loss expression of integrin α4 subunit might be a predictor indicating the invasive potential of osteosarcoma and play a role in metastasis of osteosaxcoma patients.     

Gln与rhGh对肝硬化病人肠黏膜屏障的影响

目的观察Gln与rhGh各单独应用及联合应用对肝硬化病人小肠黏膜屏障形态学和功能学的影响。方法20个肝硬化病人随机分成四组,给予等氮等热量营养支持7d,Gln+rhGh组口服Gln[0.3g/(Kg·d)]和皮下注射rhGh(10U/d);Gln组口服Gln;rhGh组应用皮下注射rhGh;CONT对照组应用相应安慰剂。观察治疗前后患者小肠黏膜通透性和十二指肠黏膜绒毛高度和隐窝深度的变化,分别比较。结果Gln+rhGh组治疗后小肠黏膜通透性有显著性的降低(P<0.05),且显著低于其他三组(P<0.05);十二指肠黏膜绒毛高度和隐窝深度有显著性的增高(P<0.05),且显著高于其他三组(P<0.05)。结论Gln与rhGh联合应用能减低肠道黏膜的通透性和维持其形态学的完整。     

粘病毒抵抗基因-1启动子88位点G/T多态性影响乙型肝炎病毒感染的自然转归

目的探讨乙型肝炎病毒（HBV）自限感染和慢性感染与粘病毒抵抗基因-1（MxA）启动子的-88位点G／T单核苷酸多态性的关系。方法收集100例抗-HBs和抗-HBc阳性的HBV自限感染者和340例慢性感染者的外周全血，提出基因组DNA；采用竞争分化聚合酶链反应技术为基础的方法进行MxA-88G／T基因分型；采用单因素Odds ratio和x^2检验等方法进行统计学分析。结果MxA-88G／G基因型（低表达型）检出率为50．2％（221／440），T／T基因型（高表达型）检出率为5．5％（24／440），G／T杂合型检出率为44．3％（195／440）。与慢性感染患者相比，自限感染患者携带较低的G／G基因型（41．0％与52．9%，P〈0．05）、G等位基因（62．5％与75．3％，P〈0．01）和较高的T／T基因型（16．0％与2．4%，P〈0．01）、T等位基因（37．5％与24．7％，P〈0．01），而两者之间的G／T杂合型差异无统计学意义。结论MxA-88G／T基因型能在一定程度上影响HBV感染的自然转归，有望成为临床上HBV感染转归的预测指标。