乳腺良性疾病的诊断与治疗——乳腺导管扩张症的诊断及治疗

一般认为乳腺导管扩张症（mammary duct ectasia，MDE）与浆细胞性乳腺炎（plasma cell mammitis，PCM）为同一种疾病，是以乳晕处集合管明显扩张、管周纤维化、炎性细胞特别是浆细胞浸润为特征的病变，为复杂而多样化的慢性良性炎症性疾病；但有人发现MDE和PCM有不同的临床表现、鉴别诊断及病理变化，治疗术式存在差异，说明是同一疾病发展的两个阶段，各有其独立性，讨论如下。     

乳腺导管内乳头状瘤50例的超声表现及病理分析

目的 评价彩色高频多普勒超声对乳腺导管内乳头状瘤的临床诊断价值及与病理对照结果.方法 对50例乳腺导管内乳头状瘤的超声表现和病理展开分析.结果 超声检查结果为,29例患者乳晕区出现导管扩张,而且导管内有实性乳头形状的块状物;21例患者扩张导管的尾部出现低弱回声团;44例患者扩张的导管内出现乳头状或颗粒状突起,6例患者患者为复合型的导管扩张,没有出现任何导管内结节;39例术前诊断为导管内乳头状瘤.以上患者的超声诊断,准确率高达78％.结论 乳腺导管内乳头状瘤的表现具有多样性的特征,而超声在诊断此疾病的过程中,具有明显的实用价值,可以为手术治疗提供可靠的临床资料.     

超声联合X线钼靶在浆细胞性乳腺炎诊断中的比较研究

目的分析彩色多普勒超声和X线钼靶在浆细胞性乳腺炎（Plasma Cell Mastic,PCM）诊断中的主要特征,并进一步确定两者联合应用在该病诊断中的价值。方法通过对已经病理证实的31例（31个）PCM患者的彩色多普勒超声和X线钼靶特征的回顾分析,明确两者在PCM中的表现。结果彩色多普勒超声表现主要划为四个类型：囊实混合型（2／31）、低回声实质型（16／31）、囊性型（8／31）、单纯导管扩张型（5／31）。其中,频谱特点为低速低阻型（10／11）,16例患者低回声实质型病灶内血流信号分别为8个0～I级,4个Ⅱ级,4个Ⅲ级。x线钼靶表现同样分为四个类型：结节肿块型（6／31）、局限浸润型（16／31）、导管扩张型（4／31）、炎性样型（5／31）。单独使用超声时,PCM阳性诊断符合率为51％,单独使用X线钼靶时,PCM阳性诊断符合率为33％,两者相比差异无统计学意义（P〉0．05）,钼靶X线与联合检查、超声与联合检查比较差异具有统计学意义（P〈0．05）。结论联合应用彩色多普勒超声和X线钼靶能够显著提升PCM的阳性诊断符合率。     

彩色多普勒超声诊断乳腺占位性病变163例分析

目的探讨彩色多普勒超声应用于乳腺占位性病变诊断中的临床意义。方法回顾性分析2011年6月---2013年6月来我院行彩色多普勒超声检查的163例乳腺占位性病变患者,并与手术、病理学及临床治疗结果进行对比。结果163例患者超声检查共诊断出196个乳腺占位性病变,其中146个实性包块和50个囊性包块,进一步确诊为83例乳腺纤维瘤、45例乳腺囊肿、29例乳腺乳头状导管癌、26例乳腺硬癌、13例乳腺增生性病变,与临床病理学检查结果基本一致,良恶性诊断符合率87％。结论彩色多普勒超声在鉴别和诊断乳腺占位性病变方面有一定的价值,可以为鉴别诊断乳腺占位性的病变情况提供依据,值得临床应用。     

乳腺癌超声普查工作中所见几种声像学特征分析

目的 讨乳腺癌普查工作中所见几种超声图像特征.方法 回顾性分析乳腺癌普查工作中具有典型声像图特征的109例患者的超声表现,并与手术病理结果相对照,分析几种所见声像图特点的超声诊断价值.结果 109例患者中病理诊断良性病变51例伴钙化27例,其中肉芽肿性小叶性乳腺炎9例,乳腺纤维腺瘤19例,纤维囊性乳腺病21例,纤维间质玻璃样变2例,恶性病变58例伴钙化36例,确诊为乳腺癌.结论 超声以其方便、无创性的检查方式成为乳腺疾病普查的首选检查方法,随着超声仪器性能的提高和高频超声在临床上的广泛应用,能发现一些乳腺微小的钙化,对其声像学特征的总结分析有助于提高乳腺癌的早期发现、早期诊断的敏感性和准确率及乳腺良恶性病变的鉴别诊断.     

乳腺导管造影在溢液性乳腺疾病中的诊断价值

目的探讨乳腺导管造影在溢液性乳腺疾病中的诊断价值。方法回顾性分析经手术和病理证实的38例溢液性乳腺疾病的导管造影表现。结果乳腺导管内乳头状瘤8例;乳腺囊性增生伴导管扩张6例;导管扩张症11例;乳腺导管扩张伴慢性乳腺炎4例;导管癌4例;导管内乳头状癌3例;导管内未见异常2例。结论乳腺导管造影对溢液性乳腺疾病的诊断与鉴别诊断具有极高的价值,为临床提供了可靠的治疗依据。     

肉芽肿性小叶性乳腺炎的诊断和治疗

目的:探讨肉芽肿性小叶性乳腺炎的临床、病理特点及治疗方法。方法:对24例经组织病理学证实的肉芽肿性小叶性乳腺炎的临床、病理学资料和治疗结果进行回顾性分析。结果:24例患者均为女性,大部分有哺乳史,以乳腺肿块就诊,临床检查、影像学检查与乳腺癌难以鉴别,均行组织病理检查后明确诊断,行手术治疗、激素治疗有较好的效果。结论:肉芽肿性小叶性乳腺炎与乳腺癌在临床特征及影像学上有相似之处,粗针穿刺组织学病理检查是有效的确诊方法,手术及激素治疗是有效的治疗方法。     

选择性乳腺导管造影术在乳腺导管疾病中的诊断价值

目的:探讨选择性乳腺导管造影术在乳腺导管疾病中的诊断价值.方法:挑选了我院资料完整有阳性表现的36例导管造影病例,分析了其X线表现.结果:导管内乳头状瘤18例,导管扩张症14例,慢性导管炎2例,导管癌2例.结论:选择性导管造影术能根据导管形态的不同表现,正确区分不同的疾病,为临床提供可靠的诊断治疗依据,具有重要的诊断价值.     

钼靶X线诊断乳腺增生临床分析

目的:探讨影像检查在乳腺增生诊断与鉴别诊断中的作用。方法:分析37例乳腺增生症患者的临床和影像学表现。37例均做了钼靶X线摄影检查,其中10例做了选择性乳腺导管造影、5例超声检查和2例核磁共振检查。结果:37例钼靶X线平片检查表现为片状高密度影22例(59.5%)、结节影9例(24.3%)、无异常发现者6例(16.2%)。10例乳头溢液患者中选择性乳腺导管造影表现为囊肿型4例,囊肿伴导管硬化型3例,导管增生硬化型1例,终末导管囊性扩张型1例。5例肿块性患者的超声表现为实性病变4例,呈低回声。囊性病变1例,呈无回声液性暗区,伴有明显的后回声增强效应。1例乳腺囊肿,T1W1呈均匀低信号,T2W1呈均匀的高信号。结论:乳腺增生症的多种影像学表现反映其复杂多样的病理特点,钼靶X线摄影联合超声、MRI检查对肿块性病变的诊断与鉴别诊断有很重要的意义。     

乳腺分级在超声诊断方面的应用

目的 探讨各种分级方法在乳腺分级中的表现,分析其在临床中的问题.方法 通过对比该院258个应用分级的诊断结果和术后的病理结果,来明确各分级中每一项指标以及分值.结果 应用了分级指标的分级诊断,其特异度69.4％(100 144)、敏感度94.7％(108 114)、准确度80.6％(208 258).结论 超声诊断分级体系在乳腺超声诊断中提供了一个可参比标准化平台,临床价值明显.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.