腹部钝伤CT诊断与临床分析

目的评价CT检查对腹部钝伤的诊断价值。方法对240例CT检出腹部脏器损伤病例进行回顾性分析。结果 240例腹部钝伤CT检出单一器官损伤125例,肝肾同时伤36例,复合伤25例,腹腔积血195例,腹膜后血肿40例。结论 CT对腹部脏器损伤的正确诊断和临床治疗提供重要信息。     

Cytopathological and immunocytochemical findings of pancreatic anaplastic carcinoma with ZEB1 expression by means of touch imprint cytology

Pancreatic anaplastic carcinoma (PAC) is rare and has an aggressive clinical course. We report an autopsy case of PAC focusing on the cytopathological characteristics of the tumor and immunocytochemical staining for vimentin, E‐cadherin, and zinc finger E‐box binding homeobox 1 (ZEB1), which markers are associated with epithelial markers of epithelial‐mesenchymal transition (EMT). A 50‐year‐old woman presented to our hospital with a chief complaint of jaundice. A pancreatic head tumor and multiple liver nodules were detected on abdominal computed tomography. Biliary cytology under endoscopic retrograde cholangiopancreatography suggested ductal adenocarcinoma. Three months after admission, she died of multiorgan failure. At autopsy, touch imprint cytology using squash preparation of the pancreatic tumor identified two different cell types; numerous isolated malignant cells with large and pleomorphic nuclei and a few clusters showing irregularly overlapped nuclei and irregular contours within the necrotic background. Immunocytochemically, isolated cells were positive for vimentin and ZEB1, and negative for E‐cadherin. Conversely, clusters were negative for vimentin and ZEB1, and positive for E‐cadherin. Histologically, the tumor was composed of sarcomatous cells with small foci of adenocarcinoma, which were consistent with a diagnosis of PAC. Immunohistochemical staining of the adenocarcinoma and sarcomatous cells corresponded to those of the clusters and isolated malignant cells, respectively. Immunostaining of these EMT markers is useful to distinguish sarcomatous cells from adenocarcinoma and can contribute to the accurate diagnosis of pancreatic tumors with EMT.     

Cytological findings of ROS1‐rearranged lung adenocarcinoma

ROS1‐rearranged lung adenocarcinoma has been recently identified. We report a case of ROS1‐rearranged lung adenocarcinoma with special emphasis on cytological findings. Here, we report a case of young woman with ROS1‐rearranged lung adenocarcinoma diagnosed by cytology and discuss the clinical, cytological, and molecular findings. Cytologically, the tumor consisted of small tight clusters of cells with high nuclear/cytoplasmic ratio. Nuclei were enlarged and small nucleoli were occasionally observed. Signet‐ring cells were focally identified. Neoplastic cells were positive for ROS1 immunocytochemistry. Subsequently, the translocation of ROS1 gene was confirmed in a histological specimen. In conclusion, the specific histology of adenocarcinoma on cytological materials should promote testing for ROS1 immunohistochemistry. Immunocytochemical detection of ROS1 protein helps identify patients suitable for molecular targeted therapy.     

实时灰阶超声造影和螺旋CT诊断肝肿瘤的比较研究

目的比较实时超声造影和螺旋CT显示肝肿瘤血流信号的特点.方法对29例肝肿瘤(原发性肝癌16例,转移性肝癌2例,血管瘤6例和肝局灶性结节增生5例)分别进行超声造影和CT检查.结果超声造影显示肝恶性肿瘤的整体型、血管瘤的周边型及局灶性结节增生的中央型出现率显著高于其他病变(P<0.01).CT示恶性肿瘤中94.4%(17/18) 动脉期强化、门脉期低密度;血管瘤中83.3%(5/6)呈结节状强化;肝局灶性结节增生动脉期均明显强化.超声造影和CT鉴别肝肿瘤的能力无显著差异.结论超声造影和CT都能敏感地显示不同肝肿瘤的血供特征.     

Current concepts in teaching and learning in surgery

Modern surgical teaching is evolving at speed. The environment in which we learn and teach is subject to a number of extrinsic pressures. These are influencing ways in which medical students and trainees learn and are taught the discipline of surgery. As a surgical educator it is useful to understand the reasons for these changes and to acquire the skills necessary to provide effective teaching. This short article looks at reasons why one would wish to develop surgical teaching skills, covers basic principles associated with delivery of effective teaching sessions and briefly reviews other avenues that may enhance teaching practice.