爆裂性骨折所致眼球内陷的CT研究

目的:研究眼眶爆裂性骨折后,眼球内陷与眼眶容积扩大的关系并对眼球内陷进行早期预报。方法:28例单侧眼眶爆裂性骨折后1～350 d患者,分别测量双侧眼球位置和骨性眼眶容积值,计算患侧眼球内陷值(E)和骨性眼眶容积扩大值(V),应用pearson积矩法研究E、V相关性并建立直线回归方程。结果:28例患侧E、V呈正相关(r=0.88,P<0.001);15例≤24 d的患者直线回归方程为E=0.85 V-1.74(r=0.86,P<0.001),13例>24 d的患者直线回归方程为E=0.86 V-0.60(r=0.9,P<0.001)。结论:眼球内陷值与眼眶容积扩大值高度相关;1 mL眼眶容积的扩大,可引起大约0.9mm(0.85～0.86 mm)的眼球内陷。与伤后>24 d的相比,≤24 d的眼球有明显的抗拒内陷的趋势,>24 d之后,这种趋势逐渐消失,随之发生眼球内陷。     

缺血性肠病CT检查与诊断

目的着重探讨45例缺血性肠病患者的病因、CT检查技术及其影像表现。资料与方法45例缺血性肠病均经螺旋CT扫描。26例经过手术证实,14例经过治疗痊愈,5例急性死亡。结果其中肠系膜动脉缺血24例,肝固有动脉缺血4例,肠系膜静脉缺血17例。结论严格掌握CT检查技术,根据CT影像表现并密切结合临床,对缺血性肠病患者可以作出确定诊断。     

Effectiveness of the Thin Prep® Imaging System in the detection of adenocarcinoma of the gynecologic system

BACKGROUND.

The ThinPrep Imaging System (TIS) has been approved by the U.S. Food and Drug Administration for use to decrease the number of false‐negative results in ThinPrep (TP) gynecologic specimens and increase cytotechnology productivity. Although the increased detection of squamous abnormalities using the TIS has been well documented, to the authors' knowledge, data regarding the impact of the TIS in the detection of glandular abnormalities is limited. The goal of the current study was to evaluate the effectiveness of the TIS in detecting glandular abnormalities in cervicovaginal specimens.

METHODS.

TIS evaluated TP tests with histologic confirmation of adenocarcinoma involving the gynecologic system were included in the current study. Two cytotechnologists independently reviewed the cases for the presence or absence of atypical glandular cells. Review results were correlated with initial cytologic and histologic diagnoses.

RESULTS.

A total of 124 cases met the criteria for inclusion in the current study. Seventy of these cases (56%) were found to contain atypical glandular cells on the TP slide. TIS was able to identify atypical cells in 97% of these cases (68 of 70 cases). Nine cases initially reported as benign were found to contain atypical glandular cells on secondary review. All but 1 of these cases contained atypical glandular cells detected by the TIS. The majority of these false‐negative cases (6 of 9 cases) derived from endometrial adenocarcinoma. No cytologic evidence of a glandular abnormality was found in the 54 remaining cases.

CONCLUSIONS.

The TIS was found to be effective in identifying atypical glandular cells in specimens containing malignant glandular cells, leading to a full review of the slide. Cancer (Cancer Cytopathol) 2008. © 2007 American Cancer Society.     

Direct uterine sampling with the Tao brush sampler using a liquid‐based preparation method for the detection of endometrial cancer and atypical hyperplasia

BACKGROUND.

Endometrial cytology sampling devices for direct uterine sampling have been shown in previous studies to be a reliable and relatively painless method for detecting endometrial lesions. The purpose of the current study was to determine the performance characteristics of endometrial cytology for the detection of malignancy and atypical hyperplasia using liquid‐based cytology specimens collected with the Tao brush sampler.

METHODS.

Brushings of the endometrial cavity were obtained from 139 hysterectomy specimens before routine histopathologic evaluation. Cytology specimens were fixed in PreservCyt and processed using ThinPrep technology. Cytology diagnoses were classified as nondiagnostic, negative, atypical, or positive for malignancy. Histopathologic findings were used as the gold standard for determining the performance characteristics of cytology.

RESULTS.

Histopathologic results from the 139 patients included 81 (58%) endometrial cancers, 7 (5%) complex hyperplasias with atypia, 2 (1%) complex hyperplasias without atypia, and 49 (35%) patients with benign histology. The number of specimens diagnosed cytologically as positive, atypical, negative, or nondiagnostic was 60 (43%), 40 (29%), 37 (27%), and 2 (1%) specimens, respectively. The overall sensitivity and specificity of cytology for detecting endometrial cancer and atypical hyperplasia were 95% and 66% when atypical cytology specimens were considered positive.

CONCLUSIONS.

The results of the current study indicate that direct endometrial sampling by liquid‐based endometrial cytology collected with the Tao brush sampler produces specimens that contain cellular material that may be identified as endometrial cancer or atypical hyperplasia. Both atypical and positive cytology diagnoses are indicators for triage to more specific methods of diagnosis. Cancer (Cancer Cytopathol) 2008. © 2008 American Cancer Society     

Liquid‐based Papanicolaou test (SurePath) interpretations before histologic diagnosis of endometrial hyperplasias and carcinomas

BACKGROUND.

In addition to the reporting of atypical glandular cells (AGC) and adenocarcinoma (ADCA), the 2001 Bethesda System requires the reporting of benign‐appearing endometrial cells in women aged >40 years (BAEMC). In this study, the authors evaluated the contribution of each of these reporting categories to the sensitivity and specificity of a liquid‐based Papanicolaou test for endometrial carcinoma or hyperplasia.

METHODS.

Over the 3‐year study period, in the setting of a large, multihospital health care system, the authors analyzed the results from liquid‐based Papanicolaou tests that were performed within the 6 months that preceded a histologic diagnosis of endometrial carcinoma or hyperplasia and that were reported according to the 2001 Bethesda System.

RESULTS.

Two hundred seventy‐two women had a histologic diagnosis of endometrial hyperplasia (n = 199) or malignancy (n = 73) within 6 months after a Papanicolaou test. In total, 188,594 Papanicolaou tests (91,385 from women aged >40 years) were interpreted during the study period and resulted in 3810 diagnoses of BAEMC, 326 diagnoses of AGC, and 30 diagnoses of ADCA. Only 28 of 73 women (38.4%) with endometrial carcinoma had cytologically AGC or ADCA reported on a previous Papanicolaou test. The reporting of BAEMC increased this sensitivity by only 5.5% (4 additional tests) but decreased the specificity of the Papanicolaou test for endometrial malignancy from 99.8% to 96%. For endometrial hyperplasias, the sensitivity of the Papanicolaou test was even lower (39 of 198 tests; 19.7%), but BAEMC represented the majority of endometrial‐type cells reported (36 of 39 tests).

CONCLUSIONS.

The reporting of BAEMC led to an only marginal increase in sensitivity that had to be weighed against the significant loss in specificity of the Papanicolaou test for endometrial neoplasia. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.     

Prescribing oral contraceptives for women older than 35 years of age

This paper addresses the use of combined oral contraceptives in women older than 35 years of age, including the potential risks and benefits, pretreatment assessment, common side effects and their management, appropriate follow-up, and diagnosis of menopause. The case-based discussion also focuses on issues that pertain to women who smoke, have hypertension, or have dyslipidemia.     

CT在骨科中的应用

目的 :探讨 CT在骨骼肌肉系统疾病的应用价值。方法 :回顾性分析经病理证实或临床随访证实的 15 89例骨骼肌肉系统病变的 CT资料 ,并与临床进行对照。结果 :创伤性病变 15 6例 ,涉及颅面骨、脊柱、四肢、骨盆等部位 ,CT可显示复杂部位的细小骨折 ,以及邻近组织的伴随改变。骨关节病 13 79例 ,包括骨关节退行性变 ,无菌性坏死和骨纤维异常增殖症 ,CT可显示椎间盘病变的程度和部位 ,对无菌性坏死及骨纤维异常增殖症亦有独特的诊断价值。骨关节感染性病变 6例 ,肿瘤性病变 13例 ,软组织病变 3 5例 ,对上述 3类疾病 CT亦可提供明确的诊断信息。结论 :CT在骨关节系统具有十分明确的诊断价值 ,可发现常规 X线不能发现的早期表现和微小改变 ,有利于临床制订治疗方案 ,并可用于临床治疗的疗效观察     

肝局灶性结节增生的不典型螺旋CT征象分析

目的探讨肝局灶性结节增生(FNH)不典型的螺旋CT征象。方法对病理证实或临床确诊的32例FNH患者37个病灶的螺旋CT征象进行回顾性分析。结果 37个病灶中,有 14个病灶直径≤3 cm,23个病灶直径>3 cm;7个病灶周边存在假包膜;22个病灶存在中央瘢痕, 其中有20个病灶直径>3 cm;所有病灶在动脉期均呈高密度,其中31个病灶肿瘤实质均匀强化。结论多发病灶、存在假包膜、无中央瘢痕、动脉期不均匀强化是FNH不典型的CT征象。征象的多样性与病灶的病理类型和病灶的直径相关。