垂体促甲状腺激素分泌瘤临床特点的比较分析

目的 比较分析垂体促甲状腺激素(TSH)分泌瘤的临床特点.方法 回顾性比较解放军总医院2006年2月-2016年10月与上海华山医院2006年4月-2013年4月分别收治的26例和20例TSH分泌瘤患者的一般资料、临床特点、实验室检查、影像学表现和病理结果 .结果 解放军总医院患者中女性略多于华山医院[57.7%(15/26)vs.45.0%(9/20)],两组诊断时年龄相当[39.5±14.1(18~67)岁vs.40.0±14.5(17~74)岁].患者就诊的首要原因均为甲状腺毒症[73.1%(19/26)vs.55.0%(11/20)],轻中度甲状腺肿是最常见体征.解放军总医院和华山医院患者血清TSH水平分别为5.06(2.97~6.27)mU/L和6.16(3.76-10.91)mU/L,TSH水平正常者以解放军总医院多见[57.7%(15/26)vs.40.0%(8/20)],华山医院则以TSH水平升高者多见.解放军总医院患者中微腺瘤相对多见[34.6%(9/26)vs.20.0%(4/20)],华山医院则以巨大腺瘤多见[20.0%(4/20)vs.7.7%(2/26)];两组微腺瘤均多见于女性,分别为66.7%(6/9)和75.0%(3/4),巨大腺瘤则均为男性.大腺瘤常常向周围组织和结构侵袭.两组患者奥曲肽抑制试验中24h时TSH抑制率范围相当,分别为37.4%~91.8%和46.5%~94.1%.两组所有经病理证实的患者中混合瘤少见.解放军总医院8例行免疫组化检查者中3例TSH阴性,12例行奥曲肽扫描者中2例阴性.结论 两家医院TSH分泌瘤患者临床上既有共性,也存在明显差异.总体上,国内TSH分泌瘤发病无明显性别差异,诊断时年龄明显小于国外资料;微腺瘤多见于女性,巨大腺瘤男性多见;血清TSH水平可正常,免疫组化TSH染色和奥曲肽扫描可阴性.     

垂体促甲状素腺瘤致多激素分泌异常一例

患者男,52岁,因“失眠、心慌3月”来诊,患者于3月前劳累后开始出现睡眠差,阵发性心慌、胸闷,伴手抖,无多食、易饥、消瘦,无腹泻,40 d前于我院查游离三碘甲状腺原氨酸(free FT3)、游离甲状腺激素(free FT4)略高,促甲状腺激素(TSH)正常,后曾反复复查均提示FT3及FT4偏高,TSH正常范围。行垂体磁共振成像(MRI)提示鞍区占位性病变,多考虑为垂体腺瘤,为明确诊断收入院。     

复合性甲状腺疾病的处理

复合性甲状腺疾病的诊治比较困难 ,自 1996年以来 ,我们治疗了 13例 ,现报告如下。1　临床资料(1)一般资料 :我院自 1996年 1月～ 1999年 10月 ,共收治甲状腺疾病 40 4例 ,其中复合性甲状腺疾病 13例 ,男2例 ,女 11例 ,占全部甲状腺疾病的 3 2 %。患者年龄 2 1～ 5 3岁 ,平均为 42岁。 (2 )术前诊断 :结节性甲状腺肿和原发性甲亢各 2例 ,结节性甲状腺肿继发甲亢 5例 ,甲状腺瘤 4例。 (3)实施手术 :诊断结节性甲状腺肿和原发性甲亢的 9例均实施了双侧甲状腺次全切 ;诊断甲状腺瘤的4例中 ,2例因诊断为单侧甲状腺瘤行 1侧甲状腺部分切除 ,2例诊…     

Graves病药物治疗后TSH增高伴摄99Tcm增强患者131I治疗

目的：探讨甲状腺功能亢进症（甲亢）抗甲状腺药物（ATD）治疗后促甲状腺激素（TSH）增高伴摄99Tcm增强患者131I治疗的可能性和必要性。方法：27例经临床ATD治疗后TSH增高伴摄99Tcm增强患者分3组，治疗组15例，及时进行131I治疗；随访观察组12例，仅作随访观察，均随访年，结果：治疗组15例中9例血清游离三碘甲状腺原氨酸（FT3），游离甲状腺激素（FT4），TSH水平及甲状腺显像均恢复正常。有2例5－6个月复查甲亢复发，第2次治疗后恢复正常，1例为早发甲低，甲低发生率为6．7％，随访观察组12例在1－4个月内均复发为典型甲亢，复发率100％，结论：甲亢ATD治疗后TSH增高伴摄99Tcm增强患者宜及时进行131I治疗。     

垂体瘤分泌TSH所致甲状腺机能亢进的临床特点和核医学诊断研究

垂体瘤分泌TSHI 临床上引起甲状腺机能亢进,在文献中仅有零星报道,自1960年发现第一例垂体性甲亢以来[1],至今为止估计约有40例左右[2~5],而垂体TSH 瘤伴肢端肥大症的则更为少见,估计不超过10例[2、5],垂体TSH 瘤伴泌乳停经综合征仅有4例[2],垂体TSH瘤伴FSH仅有一例[6]。     

垂体大腺瘤后叶高信号：MR评价其沿垂体柄消失或移位的价值

垂体后叶高信号影(PPBS)是含抗利尿激素(ADH)-转运蛋白复合物的神经分泌腺体积聚所形成的,这些腺体包被在磷脂膜内。作者收集69例向鞍隔上延伸的垂体大腺瘤,男35例,女34例,年龄17～72岁(平均46.9岁)。其中非分泌性腺瘤56例,泌乳素腺瘤6例,生长激素腺瘤5例,皮质激素腺瘤1例,卵泡刺激素腺瘤1例。61例有视力下降和视野受损,8例     

240例甲亢、甲低患者血清者激素测定分析

笔者检测了 2 4 0例甲状腺功能亢进(简称甲亢 )、甲状腺功能减退 (简称甲低 )患者的促卵泡成熟素 (ＦＳＨ)、促黄体生成素 (ＬＨ)、孕酮 (Ｐ)、雌二醇 (Ｅ2 )、睾酮 (Ｔ)和垂体泌乳素 (ＰＲＬ)水平 ,以探讨甲亢、甲低患者下丘脑 垂体 性腺轴的变化规律 ,现报道如下。一、资料与方法1 .病例资料。对照组选择无甲状腺及其他内分泌疾病的体格检查者 92例 ,其中男 4 6例 ,年龄 2 2～ 52岁 ,平均 34.7岁 ,女 4 6例 ,年龄 2 0～ 4 6岁 ,平均 32 .8岁。 1 999年 1 2月～ 2 0 0 1年 1月门诊及住院甲亢、甲低患者 2 4 0例 ,年龄 1 8～ 50岁。其中甲…     

北京市海淀区妊娠早期甲状腺疾病筛查方案探讨

目的探讨妊娠早期甲状腺功能(甲状腺功能)异常的筛查方案,制定北京市海淀区妊娠早期特异性血清TSH正常参考值。方法 (1)2011-10至2012-10在武警总医院就诊的妊娠早期(8~12周)单胎孕妇1400例,年龄18~35岁,测定血清TSH水平,对TSH>2.5 m U/L者,测FT3、FT4、TPOAb、TGAb;对TSH<0.1 m U/L者,测FT3、FT4、TRAb,按ATA指南标准统计甲状腺功能异常的发病率。(2)随机选取无甲状腺疾病病史、无甲状腺疾病家族史,无其他自身免疫性疾病史的妊娠早期(8~12周)的单胎孕妇360例,测定血清TSH、TPOAb、TGAb,排除TPOAb、TGAb阳性病例,制定北京市海淀区妊娠早期TSH的95%正常参考值,并按此标准统计甲状腺功能减退症(甲减)的发病率。结果 (1)1400例孕妇中,妊娠期甲减发病率为9.0%,其中亚临床甲减和临床甲减分别为7.36%和1.64%;在妊娠期甲减患者中,存在桥本甲状腺炎者46.03%;妊娠期甲状腺毒症发病率为3.5%,其中亚临床甲状腺功能亢进症(甲亢)和临床甲亢分别为3.14%和0.36%;在妊娠期甲状腺毒症中,妊娠甲亢综合征(gestational hyperthyroidism syndrome,GHS)占94%,妊娠Graves占6%。(2)360例孕妇去除56例TPOAb、TGAb阳性病例,剩余304例抗体阴性孕妇,计算妊娠早期血清TSH的95%正常参考值为0.1~3.6 m U/L;按TSH 0.1~3.6 m U/L计算,则1400例孕妇中亚临床甲减发病率为3.86%。结论妊娠期甲减的主要病因是桥本甲状腺炎,妊娠甲状腺毒症中大部分为GHS。妊娠早期孕妇常规检测TSH,并以本地区妊娠特异性TSH参考值为准,对TSH异常者进一步检查FT3、FT4及甲状腺自身抗体,是一项经济、有效的妊娠期甲状腺疾病筛查方法。     

原发性甲状腺功能减退症致垂体增生的MRI影像特征与误诊分析

目的 总结原发性甲状腺功能减退症(简称:原发甲减)所致垂体增生的MRI影像特点.方法 回顾性分析6例原发甲减合并鞍区占位患者的临床资料及MRI资料,经病理证实均为垂体增生.术前均被误诊为垂体腺瘤.结果 病变局限于鞍膈内,上缘膨隆者4例,其中合并鞍底下陷者2例;突破鞍膈累及鞍上者2例,其中1例累及鞍上池导致视交叉受压,另1例呈明显“葫芦形”并填充鞍上池.所有病例海绵窦均未见受累.信号特点:病变信号均匀,信号特征与正常腺垂体一致(6例),局限于鞍内者病变后方均可见正常神经垂体信号(4例).增强扫描呈明显均匀强化,延时扫描示病灶强化强度较首次均匀减低,未见异常延时增强区.结论 原发甲减所致垂体增生以垂体膨隆为主,与正常腺垂体类似.鞍区占位必须结合垂体激素和甲状腺功能检查.     

TSH受体抗体测定的临床意义

促甲状腺激素受体抗体(TRAb)是直接作用于甲状腺细胞膜上的促甲状腺激素(TSH)受体的多克隆抗体,为自身免疫性甲状腺疾病(AITD)的体液免疫。TRAb的测定在诊断自身免疫性甲状腺疾病格雷氏病(GD)及桥本氏病(HD);鉴别诊断亚急性甲状腺炎、甲状腺功能自主性结节或腺瘤;预测新生儿甲亢;判定GD疗效与预测GD复发;检测GD患者家属中有无自身免疫性甲状腺疾病的倾向以及对其它自身免疫性疾病进行辅助性检测等具有重要以及程度不等的临床意义。     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme