儿童结直肠息肉的临床特征

结直肠息肉是儿童常见病,是儿童无痛性便血的常见病因。随着儿童结肠镜检查技术的推广,越来越多的结直肠息肉患儿得到了诊断和治疗。结直肠息肉多在幼儿期、学龄前期出现症状,通过结肠镜检查,能够确认息肉的部位、大小、数量,能够进行病理检查确定其性质。儿童结直肠息肉有炎性息肉、错构瘤性息肉、腺瘤性息肉等多种类型。儿科医生需要提高认识,对有症状或有相关家族史的患儿积极进行结肠镜检查。     

Multiple soft fibromas of the lid

Fibromas are benign tumors that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchymal tissue (a type of loose connective tissue). The term “fibroblastic” or “fibromatous” is used to describe tumors like the fibroma. This 69-year-old male presented to us with giant, multiple, very slowly progressive, painless, noninflammatory, soft, trans-illuminant, pedunculated lid swellings with a two decade history. There were no other swellings on the body. He was clinically normal on systemic examination except for the immature cataracts in both eyes. The diagnosis was confirmed on histopathology. Simple excision removed all the soft fibromas virtually leaving no scar. A review of literature world-wide using Medline Plus/PubMed revealed this to be the only reported case of multiple giant soft fibromas of the lid.     

DNA ploidy pattern of flat adenomas of the large bowel

In an attempt to clarify the nature of flat adenomas, DNA content was measured by means of microspectrophotometry. Thirty-nine flat adenomas (FA), 13 with mild, 22 with moderate, and 4 with severe atypia, were collected for this study. In FA, diploidy (D), polyploidy (P), and aneuploidy (A) were found 100, 0, and 0 percent in mild atypia, 41.9, 4.5, and 54.5 percent in moderate atypia, and 0, 0, and 100 percent in severe atypia, respectively. It is assumed that FA have a much higher malignancy potential than previously expected since, histologically, benign-appearing FA with moderate atypia have already contained malignant DNA patterns. In particular, those more than 5 mm in diameter show aneuploidy in 80 percent. These data suggest that FA with moderate atypia play an important role in the pathogenesis of small colonic carcinomas.     

阑尾管状绒毛状腺瘤临床特征、内镜特点及文献复习

阑尾肿瘤临床上十分少见，占胃肠道肿瘤的0．4％。尤其是发生于阑尾的管状绒毛状腺瘤在临床上属少见病，具有癌变潜能由于本病症状不典型或无明显临床症状，特别是电子肠镜下特点总结较少，故常导致临床漏诊及误诊，为加深对本病的认识和了解，我们收集浙江中医药大学附属第一医院近年收治的阑尾管状绒毛状腺瘤患者2例，对其临床症状、病理基础和肠镜下表现进行总结分析，并进行文献复习。     

气囊辅助内镜治疗小肠息肉的临床价值研究

目的：探讨应用气囊辅助内镜（ BAE）治疗小肠息肉的可行性、安全性及临床价值。方法回顾性总结2006年8月至2014年7月对199例小肠息肉患者行BAE检查及内镜下息肉切除治疗情况,评价其可行性、安全性及小肠息肉内镜治疗的临床价值。结果199例小肠息肉患者共接受558例次BAE诊治术,摘除小肠息肉共3391枚,其中直径5～10 mm 801枚（23．62％）,11～30 mm 1887枚（55．65％）,31～50 mm 563枚（16．60％）,＞50 mm 140枚（4．13％）,最大者约为7 cm ×10 cm。发生21例次（3．76％）手术相关并发症,包括15例息肉残根出血和6例肠穿孔。结论 BAE是一种安全有效的小肠息肉治疗方法,对大多数小肠息肉患者,可替代外科手术而作为首选治疗方法,具有较好的临床应用价值及发展前景。     

寒冷—束缚应激对大鼠结肠运动的后续效应

对大鼠结肠收缩活动及排粪质量的观察发现，持续6小时的寒冷束缚应激引起其结肠动力显著增强，应激解除后60小时仍未恢复。应激尚可改变进食和P物质等生理性刺激引起的结肠动力反应。提示应激扰乱结肠运动的后续效应是多方面的，进一步支持应激与功能性肠病的可能联系。     

直径≤10 mm进展期大肠癌的内镜和临床病理特点

目的：研究直径≤10mm进展期大肠癌的内镜和临床病理特点。方法：总结12例直径≤10mm进展期大肠癌的临床资料，并与直径＞10mm进展期大肠癌的直镜下特点和临床病理作比较。结果：直径≤10mm进展期大肠癌肉眼似Ⅱc 5例，似Ⅱa 3例，似Is 4例。病灶直径6－10mm，侵犯至肌层8例，侵犯至浆膜层4例。内镜下均有黏膜皱襞集中和表面略有凹陷，以及Vs型的腺管开口型的特点。无一例分布在直肠。淋巴结转移率为33％。结论：直径≤10mm进展期大肠癌可能由表面平坦凹陷型发展而来。此类病灶可以通过黏膜皱襞改变和腺管开口类型来进行辨别。     

Higher prevalence of proximal colon polyps and villous histology in African-Americans undergoing colonoscopy at a single equal access center

Background

In the United States, African Americans (AA) have the highest incidence and mortality from colorectal cancer (CRC) of any racial group. Few studies have evaluated if AA who undergo colonoscopy are more likely to have aggressive neoplasia (polyp) tumor biology compared to Caucasians (C). The primary aim of the study was to compare polyp characteristics between AA and C undergoing outpatient colonoscopy.

Methods

A single center retrospective cohort study was performed at a single Veteran Administration (VA) health care system. The charts of 4,038 veterans undergoing colonoscopy from 2005 to 2008 were reviewed. After applying exclusion criteria, data was analyzed for 1,388 persons. Categorical variables were compared using the chi-square test and data were expressed as percentages. Continuous variables were compared using student’s t-test and the data were expressed as mean with standard deviation.

Results

A total of 37% of AA had proximal polyps compared to 21% of C (P<0.0001). Twenty-four percent of AA had polyps with villous histology compared to 16% of C (P=0.01). Twelve percent of AA had hyperplastic polyps compared to 20% of C (P=0.02). There was no difference in the overall prevalence of tubular adenomas, adenomatous polyps with high-grade dysplasia, number, size or polyp morphology between groups.

Conclusions

In an equal access healthcare system and under varying indications, AA have more proximal polyps and polyps with more aggressive histology compared to C. This could partially explain the higher incidence of CRC in AA, and the increased likelihood for AA to develop advanced proximal neoplasia.     

细胞间黏附分子-1和P-选择素在鼻息肉中的表达

目的:揭示细胞间黏附分子-1(ICAM-1,CD54)和P-选择素(CD62p)在鼻息肉发病机制中的作用.方法:收集鼻息内标本32例,炎性鼻甲黏膜11例,正常鼻黏膜12例作对照,应用FACScan流式细胞仪测定不同标本内表达这两种黏附分子的阳性细胞数量.结果:鼻息肉和炎性鼻甲黏膜ICAM-1和P-选择素的细胞阳性率均明显高于正常鼻黏膜(P＜0.001);鼻息肉和炎性鼻甲黏膜之间ICAM-1和P-选择素的细胞阳性率差异无显著性(P＞0.05);ICAM-1和P-选择素在鼻息肉中的表达有正相关关系(r=0.900 1,P＜0.001).结论:ICAM-1和P-选择素在鼻炎和鼻息肉发病过程中都起了重要作用,在鼻息肉中二者表达有一致性.