B超引导下细针穿刺对触诊阴性甲状腺结节的诊断价值

本研究对75例触诊阴性的甲状腺结节行B超检查及B超引导下的细针穿刺活检.结果 显示B超特征有助于区分触诊阴性的甲状腺结节的良恶性,B超引导下的细针穿刺细胞学检查对其有较高的诊断价值.     

肝癌特异蛋白等4种检诊法对肝癌诊断价值的评价

肝痛特异蛋白快诊断法(简称特诊),是近年来发展的新技术,为评价特诊对原发住肝癌的早期诊断价值,作者用特诊检查分别与甲胎蛋白(AFI)、B超、肝穿,进行了对照观察。结果B超诊断肝癌64例,特诊阳性符合率93.8％,肝穿诊断肝癌74例,特诊阳性符合率91.9％经统计学处理X~2=0.176,P>0.05,说明特诊检查与B超,肝穿诊断阳性率之间差异不显     

鄱阳湖区学龄儿童血吸虫病患病率的影像学评价Ⅰ.非疫区小学生肝脾大小及门脉主干内径的测量结果

目的获得鄱阳湖区6～12岁儿童肝脾大小及门脉主干内径B超测量正常值,为应用B超评价儿童血吸虫病患病率和疾病控制效果提供依据。方法按照TDR／WHO推荐的方法,对267名非疫区6～12岁小学生进行了腹部超声检查。结果获得了受检小学生肝脾大小及门脉主干内径等4项B超测量值,并进行了不同年龄、性别、身高、体重和HBVM阴阳性间的比较分析。结论提出了鄱阳湖区6～12岁儿童肝脾大小及门脉主干内径B超测量正常值的参考标准。     

血吸虫病流行区居民腹部超声显像指标典型相关及冗余度分析

目的　探讨日本血吸虫病肝、脾B超指标间以及与感染次数、感染时间和每克粪便平均虫卵数 (EPG )的相关性。　方法　采用典型相关方法分析肝、脾B超指标间及其与感染次数、感染时间和EPG的相关性 ,用冗余度分析方法分析肝、脾变异中有多少比例互为相关。　结果　男、女无既往感染组和既往感染组的第 1典型相关系数分别为0.7842、0.5483和 0.5800、0. 4220 (P值均 <0.01) ;男、女粪检阴性组和阳性组的第 1典型相关系数分别为 0.6063、0.5215和 0.6595、0.3849(P值均 <0. 01) ;男、女无既往感染组肝B超指标变异分别有 43.5 %和 17.5 %与脾B超指标变异有关 ,而既往感染组分别为 22.1%和 11.4%。而在男、女粪检阴性组分别为 26.8%和 16.8% ,粪检阳性组分别为 2 7.6%和 10.7% ;既往感染组 ,感染次数、调查时距首次感染时间和粪检阳性者的EPG与肝、脾B超指标的典型变量均无相关性 (P >0.05 )。　结论　日本血吸虫病肝、脾B超指标间具有典型相关关系 ,且男性的相关性大于女性 ;在既往感染者中感染次数、调查时距首次感染时间和粪检阳性者EPG与肝、脾B超指标的典型变量间均未发现相关性。     

触诊、B超及钼靶诊断浸润性乳腺癌原发病灶的差异性

目的探讨触诊、B超和钼靶临床上检查判断浸润性乳腺癌原发病灶的差异性。方法选择接受就诊的200例乳腺癌患者作为研究对象,对比触诊、B超和钼靶分别或联合检查浸润性乳腺癌原发病灶的结果,并与病理结果对比分析。结果触诊检查时病灶的病变率为57.0%,B超检查时病灶的病变率达88.0%,钼靶检查时的病变率为69.0%。三者比较差异有统计学意义(P0.01)。对于乳腺癌原发病灶大小的检测,触诊和B超检查结果完全一致者67.5%;触诊和钼靶检查结果一致的有33.5%,B超和钼靶检查结果完全一致者41.5%;三种方法检查均一致者27.5%。触诊、B超和钼靶三种方法检查浸润性乳腺癌的阳性预测值均大于阴性预测值,而B超的灵敏度和特异度最高,钼靶检查的灵敏度和特异度次之,触诊检查的灵敏度和特异度最差。结论对浸润性乳腺癌患者,B超检查浸润性乳腺癌患者原发病灶的准确性最高。触诊、B超和钼靶三种检查方法判断乳腺癌原发病灶的大小差异较大,临床上对于乳腺癌的各种检查方法均具有其优点和缺点,因此,临床检查时应根据各种方法的特点进行综合性的分析比较。     

肝脾包虫病1例

患者女性，30岁，上腹部胀痛一月余。查体：腹部膨隆，肝、脾肿大，肝右肋缘下2～3cm，脾左肋缘下4cm，肝、脾区轻压痛，腹部无移动性浊音。B超、CT示：肝、脾巨大囊肿。行脾切除及肝囊肿剥离术。术中见脾下极有一囊肿，表面光滑。肝右叶后方有一包块，周围与膈肌、横结肠粘连较重。肝内吸出黄白色胶泥样物约350ml，脾脏内吸出淡黄色清亮液体约200ml。     

肝硬变患者应用维生素K_1引起过敏性休克死亡1例报告

患者 男性,38岁,反复乏力、腹胀、纳差,HBsAg阳性6年伴尿少、尿黄1月入院。病程中常有鼻衄、牙龈出血及注射部位瘀斑。患者对多种药物有过敏史。入院查体:慢性肝病容,面色晦暗,皮肤巩膜轻度黄染,无肝掌,胸部可见数枚蜘蛛痣,心肺检查无异常,腹软,略膨隆,肝脾触诊不满意,移动性浊音阳性。协助检查:TBIL75μmol/L,A/G=28/37(g/L)。B超示肝脏光点增机。脾厚,门静脉宽1.6cm,脾静脉1.1cm,腹腔有液性暗区。诊断为肝炎肝硬变活动期。入院后行保肝、     

B超引导下经皮肝穿刺130例临床分析

目的评价130例肝病患者应用经皮肝穿刺技术的安全性以及该项技术在肝病诊断和治疗中的价值。方法回顾性分析我科自2004年以来接受过B超定位或引导下经皮穿刺诊断和治疗患者情况。共计130例患者列入调查,穿刺后治疗组48例,穿刺后诊断组82例。治疗结果以治疗半年后影像学检查(B超、CT、MRI)为参考,分为完全消除、基本消除和未消除3个等级;将临床诊断和介入性诊断结果进行比较,观察二者诊断的符合率。结果130例患者共进行164点穿刺,穿刺成功率为98.1%,术后无一例发生严重并发症。经皮肝穿刺后介入治疗57个病灶,共进行82次穿刺治疗,总有效率为87.7%。经皮肝穿刺后介入性诊断82例,与临床诊断符合61例,总的诊断符合率为74.4%。结论B超引导下经皮肝穿刺术临床应用广泛、安全,可大大提高肝脏疾病的诊断和治疗水平。     

钙化性纤维性假瘤l例报告

患儿,女,10岁8个月,因发现腹部包块十余天,以“腹部肿块”收入我院。查体：神志清,精神可,生命体征平稳,腹平软,肝脾肋下未及,包块触诊不清。实验室检查：HCG ＜1．00 mIU／mL, CRP ＜8 mg／L,AFP及CEA均在正常范围内。影像学检查：腹部B超：膀胱左上方腹腔内低回声占位;子宫及两侧附件未见明显异常。     

宫腔镜在诊断异常子宫出血中的临床应用

目的 探讨宫腔镜诊断异常子宫出血的价值.方法 应用宫腔镜和B超检查异常子宫出血1240例,镜下定位取材送病检或诊断性刮宫送病检,比较宫腔镜和B超与病理诊断的符合率.结果 B超诊断与病理诊断的总符合率为29.76%,宫腔镜诊断与病理诊断的总符合率为82.66%,两者间差异有统计学意义(P＜0.01);子宫黏膜下肌瘤和子宫内膜息肉两者的病理诊断符合率间差异无统计学意义(P＞0.05).结论 宫腔镜检查对异常子宫出血的诊断优于B超检查,B超检查对于子宫黏膜下肌瘤和子宫内膜息肉的诊断有一定的优越性.     

晚期血吸虫病肝纤维化与肝炎后肝硬化B超观察的比较

用EUB—200A型线阵手提式超声诊断仪,探头频率为3.5MH_z,检查晚期血吸虫病肝纤维化41例(S组)与肝炎后肝硬化30例(H组)。B超图象结果表明,S组肝实质呈光带型网络状分布,似“鱼鳞状”、“龟背样”或“地图样”改变;H组(包括有腹水者)仅见肝实质光点增粗、回声增强及分布不均,无一例呈光带型网络状分布。故认为B超用于两者鉴别诊断有重要价值。肝、脾各径线测值平均值及门、脾静脉主干内径测值平均值结果,S组均大于H组,经统计学处理,差异有非常显著意义(P<0.01)。     

Detailed clinical and ultrasound examination of children and adolescents in a Schistosoma mansoni endemic area in Kenya: hepatosplenic disease in the absence of portal fibrosis

Hepatosplenic schistosomiasis involving organomegaly, portal fibrosis and portal hypertension has been observed in autopsy studies. Here, we have tested the hypothesis that hepatosplenic disease including organomegaly and markers of increased portal pressure can occur in school aged children in the absence of fibrosis. A case-only study of 96 children aged 7-20 years defined by ultrasound detectable hepatomegaly was undertaken in Makueni district, Kenya. A novel method of clinical examination that involved a consensus scoring by three or four examiners was used to classify children as presenting with severe or moderate hepatosplenic disease after palpation of livers and spleens. Ultrasound examination of livers and spleens was based on the Niamey protocol. Clinical measurements included spleen enlargement along the mid-clavicular and mid-axillary lines, liver enlargement along the mid-sternal (MSL) and mid-clavicular lines, as well as organ consistency. The clinical examination indicated that 9% and 60% of the children had severe or moderate hepatosplenomegaly, respectively. Amongst egg-positive children, all clinical measurements, except MSL liver enlargement, correlated with egg count, as did portal vein diameter, spleen length and liver length measured by ultrasound. Peri-portal fibrosis was not observed in any child, whereas 28% of the children were classified as having increased portal pressure according to World Health Organization criteria. There was no effect of malaria parasitaemia or hepatitis seropositvity on any of the observed parameters. These results indicate that hepatosplenic disease in school-aged children attributable to S. mansoni infection, involving hepatosplenomegaly and increased portal vein diameter, can occur in the absence of peri-portal fibrosis.     

Validity of selected clinical signs and symptoms in diagnosis of Schistosoma mansoni infection.

Sensitivity, specificity and positive predictive values of selected clinical signs and symptoms in the diagnosis of Schistosoma mansoni infection were evaluated in 403 individuals (69% of inhabitants over 1 year of age) in an endemic area in Brazil (Divino). Highest sensitivity (13%) was found for blood in stools. Specificity over 90% was found for blood in stools, palpable liver with normal consistency and palpable hardened liver at middle clavicular (MCL) or middle sternal lines (MSL). Hardened liver at MSL (83%) or MCL (75%), and blood in stools (78%) presented higher positive predictive values for S. mansoni infection, while palpable liver with normal consistency at MCL (45%) or MSL (48%) presented smaller values. Enlarged liver without specification of its consistency has been traditionally used as an indicator of the infection in areas where malaria or Kala-azar are not endemic. Our results demonstrate that the probability that a person with blood in stools or hardened palpable liver is infected is higher than among those with palpable liver with normal consistency.     

MEASUREMENT OF THYROID SIZE BY ULTRASOUND, PALPATION AND SCINTISCAN

Thyroid gland size was calculated from grey-scale ultrasound images in twenty patients with goitre. Results were compared with measurements by palpation and in some cases with measurements by scintiscan and at operation. There was a good correlation between ultrasound measurements and both the size of surgical specimens and clinicians' estimations, although clinicians under-estimated the size of large (> 40 ml) goitres compared with ultrasound and surgical specimens. Gland size calculated from scintiscan did not correspond well with measurements by ultrasound or palpation.     

Harnessing RNAi-based nanomedicines for therapeutic gene silencing in B-cell malignancies

Despite progress in systemic small interfering RNA (siRNA) delivery to the liver and to solid tumors, systemic siRNA delivery to leukocytes remains challenging. The ability to silence gene expression in leukocytes has great potential for identifying drug targets and for RNAi-based therapy for leukocyte diseases. However, both normal and malignant leukocytes are among the most difficult targets for siRNA delivery as they are resistant to conventional transfection reagents and are dispersed in the body. We used mantle cell lymphoma (MCL) as a prototypic blood cancer for validating a novel siRNA delivery strategy. MCL is an aggressive B-cell lymphoma that overexpresses cyclin D1 with relatively poor prognosis. Down-regulation of cyclin D1 using RNA interference (RNAi) is a potential therapeutic approach to this malignancy. Here, we designed lipid-based nanoparticles (LNPs) coated with anti-CD38 monoclonal antibodies that are specifically taken up by human MCL cells in the bone marrow of xenografted mice. When loaded with siRNAs against cyclin D1, CD38-targeted LNPs induced gene silencing in MCL cells and prolonged survival of tumor-bearing mice with no observed adverse effects. These results highlight the therapeutic potential of cyclin D1 therapy in MCL and present a novel RNAi delivery system that opens new therapeutic opportunities for treating MCL and other B-cell malignancies.RNA interference (RNAi) can be activated by introducing synthetic short double-stranded RNA fragments, termed small interfering RNAs (siRNAs), into cells to silence genes bearing complementary sequences. RNAi holds great promise as a powerful tool for evaluating the role of specific genes in cellular and disease processes and for therapeutic applications (1, 2). siRNAs that manipulate gene expression in leukocytes could be used to understand hematologic cell biology and to develop novel therapeutic approaches to dampen inflammation and the harmful immune responses that occur during autoimmunity; to suppress lymphotropic viral infections, such as HIV; or to treat blood cancers (3). However, the lack of systemic delivery startegies to target leukocytes foils these applications.Here we devised a new strategy to target B-cell malignancies using mantle cell lymphoma (MCL) as a prototypic blood cancer to validate this siRNA delivery approach. MCL is an aggressive B-cell malignancy characterized by a t(11:14) chromosomal translocation that juxtaposes the proto-oncogene encoding cyclin D1 (cycD1) to the Ig heavy chain gene promotor (4). This leads to constitutive overexpression of cycD1, a protein that is not expressed in healthy B-lymphocytes. Current MCL therapy relies mainly on conventional chemotherapy; anti-CD20 cytotoxic monoclonal antibodies; autologous stem cell transplantation; and, more recently, small molecule inhibitors of critical molecular pathways, such as the BTK inhibitor ibrutinib (5). Unfortunately, relapse and progressive resistance to treatment lead to short median survival. MCL has one of the worst prognoses among lymphomas (6–8). Thus, there is a need for new therapeutic approaches.We previously showed that cycD1 down-regulation in MCL cell lines using RNAi inhibits proliferation and causes cell cycle arrest and apoptosis (9). However, the clinical application of this approach is hindered by the lack of appropriate systems that could deliver RNAi payloads to MCL cells in an efficient and safe manner (10, 11). RNAi therapeutics for B-cell malignancies is especially challenging because these cells are dispersed and are intrinsically resistant to transfection with nucleic acids (3, 12, 13). Therefore, to test the potential therapeutic effect of cycD1 inhibition in vivo and to demonstrate the feasibility of RNAi therapeutics in MCL, we needed to develop a suitable RNAi-delivery platform for potent gene silencing.Lipid-based nanoparticles (LNPs), composed of ionizable lipids that incorporate siRNAs, can induce potent gene silencing in the liver (14, 15). These are currently being evaluated in a phase III clinical study to knock down the TTR gene expressed in the liver to treat familial amyloidosis (16). We recently demonstrated that LNPs could be surface-modified with a natural ligand or a monoclonal antibody to improve in vivo delivery of siRNA payloads (17, 18). Here we investigate the use of antibody-targeted LNPs to deliver siRNAs to MCL cells. The blood supply in the hematological tissues where MCL cells mostly reside, including spleen and bone marrow, is made up of sinusoids that allow small nanoparticles tissue access. Selective targeting of lymphoma cells by antibody-targeted delivery should be clinically beneficial because it could reduce the total amount of drug required for therapeutic benefit and reduce toxicity to bystander cells (2, 12).CD38 is expressed on the surface of immature hematopoietic cells, including immature B cells. Its expression is tightly regulated during B-cell ontogeny; it is expressed on bone marrow precursors, but not mature B cells. CD38 is expressed on most MCLs (19). In the present study, we show that CD38 is a suitable target for antibody-mediated delivery of therapeutic siRNAs to MCL. LNPs–siRNA coated with an anti-CD38 monoclonal antibody (αCD38 mAb) showed specific MCL binding in vitro (in MCL cell lines and MCL primary lymphomas) and in vivo (in mice xenografted with a human MCL cell line). CD38-targeted LNPs (αCD38-LNPs) entrapping siRNA against cycD1 (siCycD1) were specifically taken up by MCL xenografts. αCD38-LNPs-siCycD1 induced gene silencing, suppressed tumor cell growth in vitro, and prolonged the survival of MCL-bearing mice. Our data demonstrate the effectiveness of inhibiting cycD1 in MCL in vivo and highlight αCD38–LNPs–siRNA as part of a strategy that could ultimately become a novel therapeutic modality for treating MCL and other CD38-expressing hematological malignancies.     

RUPTURE OF THE SPLEEN IN INFECTIOUS MONONUCLEOSIS: A CLINICOPATHOLOGIC REPORT OF SEVEN CASES

1. Seven cases of ruptured spleen as a complication of infectious mononucleosisare described and reference made to the 3 cases previously recorded in the literature.

2. It proved possible to make an objective histologic diagnosis of infectiousmononucleosis from well prepared sections of the spleens. The diagnosis wasbased on: (a) a blurred architectural pattern due chiefly to large numbers of atypical lymphocytes diffused throughout the pulp and clumped in the blood sinuses;(b) small, poorly defined follicles, usually without germinal centers, in less thanusual numbers per unit area; (c) cellular "infiltrates," composed largely of normaland atypical lymphocytes, in the capsule and trabeculae, in the adventitia ofsmall intratrabecular arteries, and in the subintimal zone of collecting venoussinuses and intratrabecular veins; (d) swelling of the lining or attached cells ofthe blood sinuses.

3. "Infiltration" of the capsule and trabeculae reached considerable proportions, occasionally to the point of complete dissolution of these structures, andserved as a predisposing cause of rupture. The same changes were noted in intactspleens from fatal cases of infectious mononucleosis.

4. The spleen in infectious mononucleosis was 3 to 4 times normal size andruptured during the third or fourth week of the disease.

5. The importance of trivial injury as the exciting cause of so-called "spontaneous" rupture of the spleen has been emphasized. It is recommended thatextreme caution be employed during attempted palpation of the spleen in a suspected case of the disease. When the diagnosis is obvious, splenic palpation maywell be omitted.

     

LECTURES ON THE THEORY AND PRACTICE OF MEDICINE;: NOW IN COURSE OF DELIVERY AT THE THEATRE OF ANATOMY AND MEDICINE,WEBB-STREET,SOUTHWARD

DISEASES OF THE LIVER, PANCREAS, AND SPLEEN.—Frequency of disease of the liver; it is greatly susceptible of changes in form and size. Nerves of the gall-ducts. Inflammation of the liver; its history, symptuss, and treatment. Venous and bilious congestion of the liver. Encephalonis. Tubercles. Hydatids. Fatty liver. Cirrhosis. Diseases of the biliary ducts ; obstruction; calculi ; rupture of the gallbladder. Diseases of the pancreas. Diseases of the spleen; inflammation; organic disease.     

Factors Affecting the Quantitative Liver–Spleen Scan in Normal Individuals

The quantitative liver–spleen scan (QLSS) can estimate the functional hepatic mass and the organ volumes by precise measurement of sulfur colloid (SC) distribution. The normal range determined in prior studies was estimated from patients with absence of chronic liver disease in which intense fasting appeared to produce slightly abnormal values. This study was to determine the effect of fasting or fed status and colloid particle size on quantitative measurements from the QLSS in a small cohort of normal individuals. Twelve persons without any medical problems had QLSS taken twice, 2 weeks apart, one fasting and one postprandial. Patients were scanned after injection of 5–6 mCi of SC; six patients were given solution A (5- to 12-m particle size) and six patients solution B (2- to 12-m particle size). SPECT and planar analysis were performed. SC distribution of total counts between the liver and the spleen {[L/(L + S)]_t ratio}, liver–spleen index (LSI), and liver–bone marrow index (LBI) were calculated. The perfused hepatic mass (PHM) is the average of the LSI and LBI. Spleen and liver volumes are expressed as milliliters per pound ideal body weight (IBW). Results showed that the liver and spleen volumes (solution B postprandial, 9.27 ± 2.48 and 1.47 ± 0.57 ml/lb IBW, respectively) and LBI were not affected by the type of SC solution or by ingestion status. L/(L + S) total and pixel count ratios were significantly higher for solution B and postprandial studies. [L/(L + S)]_t, LSI, and PHM increased significantly (P < 0.05) from fasting to postprandial for solution A (0.71 ± 0.13 vs 0.79 ± 0.08, 80 ± 14 vs 91 ± 8, and 102 ± 10 vs 106 ± 8, respectively) and for solution B (0.81 ± 0.05 vs 0.90 ± 0.02, 86 ± 4 vs 95 ± 3, and 101 ± 5 vs 110 ± 3). Neither fasting nor postprandial LSI and PHM were significantly different between solution A and solution B. We conclude the following. (1) The QLSS functional indices in true normal patients fall within the previously reported normal range. (2) Calculated liver and spleen volumes are not altered by fasting or sulfur colloid particle size. (3) Fasting significantly decreased the [L/(L + S)]_t, LSI, and PHM. (4) A postprandial scan may be preferable since the normal values for [L/(L + S)]_t, LSI, and PHM are greater, with a narrower range, than fasting values.     

Spleen Enlargement in Patients with Nonalcoholic Fatty Liver

Our purpose was to determine if there is an association between nonalcoholic fatty liver and spleen enlargement. Spleen volume was measured by computed tomography (CT) in 32 patients with nonalcoholic fatty liver (23 men and 9 women; age, 41.6 ± 12.1, range, 22–69 years) and 34 patients with normal liver (19 men and 15 women; age, 51.1 ± 16.2, range, 14–86 years). The values were compared with the patient's demographic data, the liver-to-spleen (L/S) ratio of CT Hounsefield unit measurements, and the results of liver function tests. Diagnosis of fatty liver was made if the L/S ratio was less than 1.0. The mean spleen volume was 73.0 ± 24.4 cm³ (range, 21.1–106.1) in normal subjects and 141.2 ± 54.1 cm³ (range, 44.1–267.3) in patients with fatty liver (P < 0.0001). Multivariate linear regression analysis identified that only the L/S ratio (P < 0.0001) and age (P < 0.01) were significantly correlated with spleen volume. Using forward selection stepwise regression, the L/S ratio entered first ( = –0.634) and age second ( = –0.293). In conclusion, spleen enlargement was commonly seen in patients with nonalcoholic fatty liver, and the recognition of this association may halt further attempts to evaluate the cause of spleen enlargement.     

晚期血吸虫病患者乙型肝炎病毒DNA的检测及其意义

３１例晚期血吸虫病患者血清及肝组织乙型肝炎病毒ＤＮＡ（ＨＢＶ－ＤＮＡ）阳性率分别为９．７％及１９．４％低于血清及肝组织乙型肝炎病毒表面抗原（ＨＢｓＡｇ）检出率（分别为２９％及４８．４％），ＨＢＶ－ＤＮＡ阳性者病死率高（６６．６％），且死亡与肝病直接相关（肝衰竭及原发性肝癌）。ＨＢＶ－ＤＮＡ阴性患者病死率较低（１２％），其死亡与肝病无直接关系。结果提示，检测晚期血吸虫病患者ＨＢＶ－ＤＮＡ有重要意义。抗乙型肝炎病毒治疗对改善存在ＨＢＶ复制的晚期血吸虫病患者预后可能有重要作用，在血吸虫病疫区普及乙肝疫苗接种将对血吸虫病防治工作产生重大效益。