穿刺活检联合微波消融治疗高龄患者肺单发恶性倾向小结节

目的观察CT引导下经皮穿刺肺活检联合同步交叉法微波消融治疗高龄患者肺单发恶性倾向小结节的疗效。方法将48例肺单发恶性倾向小结节高龄患者随机分为2组,每组24例。试验组于穿刺活检后经异穿刺点交叉针道进行微波消融,对照组穿刺活检后经同轴套管同针道行微波消融,对比2组技术成功率、疗效、总有效率及并发症发生率。结果2组穿刺活检和微波消融操作成功率、总有效率及局部控制率均为100%。试验组中、重度气胸发生率为20.83%(5/24),对照组为58.33%(14/24);试验组中、大量胸腔积液发生率为8.33%(2/24),对照组为37.50%(9/24);试验组中、大量咯血发生率为12.50%(3/24),对照组为48.83%(11/24);组间差异均有统计学意义(P均<0.05)。随访6个月,2组患者均未出现并发症。结论CT定位下经皮穿刺肺活检联合同步交叉法微波消融治疗高龄患者肺单发恶性倾向小结节疗效确切,安全性较好。     

揿针穴位埋针对社区H型高血压 痰湿壅盛证的临床疗效研究

摘 要：目的： 探讨揿针穴位埋针对社区 H型高血压痰湿壅盛证的临床疗效,为 H型高血压的治疗提供参考。方法： 将 80例H型高血压痰湿壅盛证患者按照随机单盲法分为对照组（n=40）和治疗组（n=40）。对照组给予含马来酸依那普利叶 酸片（依叶片）的降压方案进行治疗。治疗组在对照组基础上给予揿针穴位埋针法进行治疗,连续治疗 28天后进行临床疗 效比较。结果： 治疗后,治疗组患者Hcy水平、中医证候积分较对照组显著降低;且治疗组证候积分比对照组显著减少;治 疗组患者血脂水平较对照组显著改善。结论： 在依叶片降压方案治疗的基础上,给予揿针穴位埋针可显著改善 H型高血压 痰湿壅盛证患者的血压、Hcy和血脂水平,且安全性较高,对肝肾功能无影响。     

Cytopathologic analysis of paraspinal masses: a study of 59 cases with clinicoradiologic correlation

Paraspinal masses (PSM) are uncommon and present a wide spectrum of differential diagnoses on fine-needle aspiration (FNA). We analyzed 59 cases of PSM on FNA in a 15-yr period, in the context of clinicoradiologic correlation. Radiologic findings, clinical data, and tissue biopsies were reviewed. Patients were 14-83 yr of age (mean 54.7) with a M:F ratio of 1.36:1. Of the 59 cases, 39 (66%) were deemed diagnostic. Of these, 8 (21%) revealed nonneoplastic lesions and 31 (79%) yielded neoplasms: 2 (6%) benign and 29 (94%) malignant. Of the malignant cases, 22 (76%) were metastatic tumors from various sites, while 7 (24%) were cancers from local spread, which included non-Hodgkin's lymphoma (NHL, 5) and myeloma (2). Benign neoplasms were nerve sheath tumors. Metastatic tumors consisted of adenocarcinoma, 9; squamous-cell carcinoma, 3; renal-cell carcinoma, 1; and non-small-cell carcinoma/not otherwise specified (NOS), 9. Twenty-four (41%) cases received further studies: immunoperoxidase (IPOX) alone, 17 (71%); special stains for microorganisms, 2 (8%); IPOX/other special stains, 4 (17%); and flow cytometry analysis, 1 (4%). Eight (14%) cases received follow-up biopsies. Half of these biopsies added information to previously "nondiagnostic" FNAs. Of the previously "diagnostic" FNAs, tissue biopsy yielded no additional information. Cytopathologic diagnoses were consistent with the pre-FNA radiology analyses in 13 (39%) cases. In instances of radiologic and cytopathologic discrepancy (4 cases, 12%), diagnoses made by FNA reversed the initial radiologic impression of neoplasm to infection, and vice versa. PSMs are rare lesions (0.26% of total FNAs done in 15 yr at our institution). The most common lesion encountered is metastatic adenocarcinoma, followed by NHL. Ancillary studies are helpful in difficult cases. In cases of radiologic/cytopathologic discrepancy, FNA diagnoses are more accurate and decisive for patient management. The sensitivity and specificity of a PSM FNA are 88% and 75% respectively.     

Dry tap bone marrow aspiration: clinical significance

Failure to obtain bone marrow on attempted marrow aspiration, "dry tap," has commonly been ascribed to faulty technique. All reports of simultaneous marrow aspirations and biopsies performed at the University of Virginia between January 1, 1983, and July 1, 1989, were reviewed to determine the frequency of dry taps, the diagnoses and pathologic findings in these cases, and the associated laboratory findings. Among 2,235 simultaneous bone marrow aspirations and biopsies, 87 were dry taps (3.9%). Of these 87 dry taps, only six (6.9%) showed normal marrow biopsies, whereas the majority showed significant marrow pathology, usually associated with fibrosis, or hypercellularity, or both. These conditions most likely account for the inability to aspirate marrow. The most frequent diagnoses were metastatic carcinoma (17.2%), chronic myelogenous leukemia (14.9%), idiopathic myelofibrosis (13.8%), and hairy cell leukemia (10.3%). The presence of peripheral blood nucleated red blood cells, thrombocytopenia, and elevation of the serum lactate dehydrogenase were frequent findings in patients who experienced dry taps. Methods to obtain sufficient marrow for rapid diagnosis in these cases are discussed.     

Transurethral microwave needle ablation for bladder cancer

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静脉输液拔针后按压血管时间的临床探讨

目的静脉输液拔针后,按压血管多长时间较为合适,目前尚无定论。旨在探讨按压血管的最佳时间,以便最大限度地减少皮下瘀血,减轻病人痛苦,保护静脉血管。方法对200例静脉输液病人拔针后不同按压血管时间的效果进行了观察,并根据统计处理结果进行分析、比较。结果拔针后4min左右较为合适,能够有效地防止瘀血,时间过长,多数病人难以坚持;过短则皮下瘀血率高。结论这种做法,克服了过去静脉输液拔针后,按压血管时间随意性较大的缺陷,应大力推广。     

细针吸取活检细胞学在乳腺癌诊断中的应用

目的：探讨细针吸取活检细胞学对乳腺癌的诊断价值。方法：以术后病理诊断为对照（１３４例）,光镜下观察５２１例乳腺肿瘤的针吸涂片。结果：在５４例乳腺癌中,细胞学诊断正确者４９例（９０．７％）,可疑者４例（７．４％）,假阴性者１例。同期细胞学诊断为乳腺癌者未见假阳性。结论：细针吸取活检对乳腺癌的定性和分级诊断均准确可靠。     

The Value of Fine Needle Aspiration Cytology in Breast Fibromatosis: Study of Two New Cases and Review of the Literature

▪ Abstract: We report two new cases of breast fibromatosis studied by needle aspiration cytology observed in a 32-year-old man and a 49-year-old woman. The lesions manifested as palpable, painless, and firm masses of the para-areolar breast soft tissues. Preoperative fine needle cytology revealed scant cellularity, featuring oval and spindle cells with bland nuclei and occasional larger polygonal cells with high nuclear:cytoplasmic ratio. Histologically, interwoven fascicles of spindle cells with bland nuclei, infiltrating the adjacent breast fat, were recognized. Based on available reports in the literature, we concluded that needle aspiration cytology, although not entirely specific, may be a source of important information in patients with breast fibromatosis. In particular, it confidently allows the exclusion of breast cancer and other more common diseases and is useful in planning a surgical approach to the lesion. ▪     

Pulmonary Failure After Norwood Procedure: Indication for Extracorporeal Membrane Oxygenation? A Case Report

Today some authors consider univentricular repair a contraindication for postoperative cardiac extracorporeal membrane oxygenation (ECMO). The question is whether or not ECMO is indicated as pulmonary support in case of an overwhelming pulmonary infection during the postoperative course after a Norwood procedure. During the prolonged weaning period after a Norwood procedure using a 4 mm aortopulmonary shunt, proven respiratory syncytial virus (RSV) bronchiolitis occurred at the time of expected weaning from artificial ventilation. Venovenous ECMO was able to improve oxygenation, but when pulmonary opacification failed to resolve, ECMO was terminated after 12 days.     

《伤寒论》水气证治论析

就《伤寒论》水气的涵义、致病特点、形成与发病、证治等方面进行了分析和探讨。认为：水气是一个病理概念,具有病理产物和致病因素的双重性,其本质是体内停蓄之水,其致病过程具有动而不居的特点;痰饮、水肿、湿痹皆是水气为患。水气的形成机制是阳虚,阳不制阴。治疗以“温药和之”为常法,振奋阳气以祛除水气;非尽以温药和之为变法,攻逐、清热、滋阴皆在其中。