乳腺影像学报告及数据系统:超声良恶性病变鉴别诊断初探

1992年美国放射学会制定了乳腺影像学报告及数据系统(breast imaging reporting and data system,BI-RADS),2003年第四版修订时包括了超声诊断(BI-RADS-US)。本文旨在初步探讨BI-RADS-US对于乳腺良恶性病变鉴别诊断的能力。我们收集了2006年1月至2007年3月期间、获得病理诊断的乳腺占位性病变共69例72灶。均为女性,年龄14-83岁,平均41.6岁。首先根据一般的非BI-RADS标准,做出良恶性鉴别。然后用BI-RADS-US标准进行鉴别和分级(0-6级),其中2级和3级为良性和良性可能性大,4级为性质待定,5级为恶性可能性大。计算并比较上述两种方法的准确性、敏感性、特异性。结果在72病灶中,根据非BI-RADS标准,诊断为良性者40灶,符合病理诊断者38灶(95.0%),诊断为恶性者23灶,符合病理者18灶(78.3%);诊断为性质待定者9灶。根据BI-RADS-US标准和分级,2级和3级共有37灶,与病理结果符合者为36灶(97.2%);5级有31灶,与病理符合者为22灶(71.0%);4级有4灶。非BI-RADS和BI-RADS-US的准确性各为83.3%和81.9%(P=1.000),敏感性各为91.7%和95.8%(P=1.000),特异性各为79.2%和75.0%(P=0.754)。总之,第一版BI-RADS-US在乳腺良恶性病变鉴别诊断方面的初步应用表现出较高的敏感性,而与非BI-RADS方法比较则尚无明显差别。     

动脉性血管外皮细胞肉瘤栓塞术和全切除术1例报告及文献复习

作收治1例眶内动脉性血管外皮细胞肉瘤(HPS)，经供血动脉栓塞后，行肿瘤全切除获得成功。现报道如下。     

老年人间质性肺纤维化同种异体单肺移植一例

患者男性,64岁,体重64kg,身高155cm。进行性胸闷、憋喘、呼吸困难1年半。2004年11月胸部 CT 检查诊断为双肺弥漫性间质性肺纤维化。药物治疗效果不佳,需频繁住院,间断吸氧,且住院时间延长。入院时一次平稳步行50m 左右即出现呼吸困难、大汗淋漓、甚至黑矇。实验室检查:白细胞10.2×10~9/L,肝、肾功能正常。痰培养:铜绿假单胞菌及克柔念珠菌生长。动脉血气分析:pH7.509,动脉血氧分压(PaO_2)65 mm Hg,动脉血     

A new method for early diagnosis of carcinoma in bile duct-sonography of common bile duct before and after injection of ceosunin.

42 cases of dilatation (7-15 mm) of extrahepatic bile duct after ceosunin injection (cholagogic method) were observed ultrasonographically. Among the 18 cases of testified obstructive lesions of the bile duct, 13 (72%) showed widening of the bile duct with an increase of calibre from 9.8 mm to 11.7 mm, 3 (16%) had no obvious change, and 2 (12%) shrank. Among the 24 cases of non-obstruction 22 (92%) shrank with a decrease calibre from 9.6 mm to 6.3 mm, and 2 (8%) showed no obvious change. After receiving cholagogue, 9 cases of periampullary carcinoma in the obstructive group were confronted with widening of the bile duct calibre. After longitudinal and transverse rotation scanning method was used, 8 of the 9 cases had their tumor mass visualized. Combined cholagogic and rotation scanning methods raised the lesion manifestation rate of lower bile duct from 41% to 88%. A dilated bile duct unable to show shrinkage of calibre after cholagogue injection is believed to be a criterion for judging the presence of     

脑血管母细胞瘤的外科治疗(附38例报告)

目的总结、探讨脑血管母细胞瘤的外科治疗。方法对38例脑血管母细胞瘤的临床表现、手术治疗进行回顾分析。结果30例囊性肿瘤均行瘤结节全切除术;随防3～20年,未复发29例。8例实体性肿瘤中,4例先行血管内栓塞后行全切除术,另4例因术中大出血行大部分和部分切除;随访3～12年,全切除的4例未复发,非全切除者1例无变化,1例增大,2例死亡。结论囊性血管母细胞瘤外科治疗易做到全切除,疗效好。实体性血管网状细胞瘤外科治疗因血管丰富,可先行血管内栓塞,减少术中出血量,提高切除率。     

侧脑室肿瘤的显微外科治疗19例报告

目的 分析探讨侧脑室肿瘤临床特点及手术体会。方法 回顾分析我院近6年手术治疗的19例侧脑室肿瘤患者临床资料。结果 侧脑室肿瘤临床无特异症状，据肿瘤的具体部位选择合适的手术入路。肿瘤全切10例，大部分切除6例，切除3例。术后症状明显改善14例。结论 侧脑室肿瘤以脑膜瘤、星形细胞瘤、室管膜瘤多见，但各有其好发部位。手术入路选择应结合肿瘤具体位置、大小和血供情况，既要满足暴露。尽量减少神经功能缺失，又要达到全切肿瘤目的。     

流行性出血热患者的血液流变学改变

<正>我们对34例流行性出血热(EHF)患者作了血液流变学检测,与健康人检测结果对照,了解EHF患者各期血液流变学的变化,以协助判断病程进展,指导治疗。现将检测结果报道如下。     

Transcutaneous ultrasound of the cervical esophagus in patients with esophageal carcinoma.

Transcutaneous ultrasound of the cervical esophagus was performed in 46 patients with esophageal carcinoma and in 35 controls. The former had 24 upper segmental lesions and 22 lower segmental lesions. The level of the sternoclavicular joint was used to divide the esophagus into the upper segmental (USE) and lower segmental esophagus (LSE). The anterior esophageal wall thickness and luminal dimensions were measured before and immediately after phonation. The mean wall thickness in the controls was 1.8 mm before phonation and 2.1 mm after phonation, with a significant difference (t test,P<0.05). The mean wall thickness in the USE carcinoma group was 4.3 mm and 4.4 mm before and after phonation respectively. There was a significant difference between the controis and USE carcinoma groups (t test, P<0.05). The cross sectional area, which was calculated as the product of anteroposterior and lateral diameters, averaged 28 mm~2 before phonation in the controls and increased to 44 mm~2 after phonation (t test, P     

沈阳市生猪工厂化屠宰检疫工作的实践与成效

几年前沈阳市内每天对猪肉的需求量在4000头左右。全市不同条件的屠宰厂最多时达1300多个,屠宰厂猪肉运输、零售等环节的卫生情况差,以及税收失控,具有先进技术水平的市肉联厂和各区(县)食品公司的屠宰设备被闲置不用,使国家和消费者受到严重损失和危害。特别是忽视了生猪生产的卫生问题。目前的生猪饲养还是以散养私养为主,屠宰的猪来源比较分散,而猪     

周边型小肺癌的几个临床问题

我科共手术治疗原发性肺癌 5 87例 ,包括周围型小肺癌 49例 ,其中腺癌 2 9例 ,鳞癌 9例 ,腺鳞癌 3例 ,大细胞癌 2例 ,未分化小细胞癌 6例。pTNM分期 ,Ⅰ期 (T1N0 M0 ) 3 2例 ,Ⅱ期 (T1N1M0 ) 9例 ,ⅢA期 (T1N2 M0 ) 8例。共实行 5 2术次 ,( 3例I期腺癌术后复发二次手术 )。结果鳞癌的 5年生存率优于腺癌和其他组织类型肺癌 ;同组织类型小肺癌比较 ,N0 优于N1,N1优于N2 。既便是早期小肺癌 ,尤其是腺癌 ,预后也不全令人乐观。初步研究结果提示 ,小肺癌并不全是早期肺癌 ,术后的综合治疗仍是不可缺少的。