甲状腺呈胸腺样分化癌的临床病理特点

目的 探讨甲状腺内与胸腺有关的肿瘤病理形态学特点、鉴别诊断及来源.方法 对2例甲状腺呈胸腺样分化癌(CASTLE)的病理学、免疫组化结果进行观察,结合文献并对照CD5标记的多组织芯片讨论这组肿瘤的来源及鉴别诊断.结果 2例呈胸腺样分化的甲状腺癌为境界清楚的结节状.镜下肿瘤组织结构、细胞特点以及免疫表型都与纵隔胸腺发生的鳞状细胞癌一致,特别是肿瘤都表达CD5这一胸腺癌特异性抗体.结论 呈胸腺样分化的甲状腺癌是罕见的甲状腺恶性肿瘤,其形态学及免疫组化支持其由异位胸腺或腮囊分化而来.CD5( )有助于鉴别诊断.彻底切除肿瘤且无局部淋巴结转移预示预后良好.     

分化型甲状腺癌的CT表现

目的分析分化型甲状腺癌患者的CT表现,探讨CT在分化型甲状腺癌及转移的诊断价值。方法回顾性分析30例分化型甲状腺癌患者的影像学特征。结果 22例癌性病灶密度不均匀,16例有钙化,5例为囊性伴高密度乳头状结节,病变呈不均匀结节样强化19例,薄壁强化7例,向心性强化4例,累及气管4例,10例颈淋巴结转移,肺转移4例,骨转移2例。结论 CT是诊断分化型甲状腺癌及转移的首选方法,对临床诊断和治疗有重要价值。     

64排螺旋CT检查在甲状腺癌临床诊断中的应用价值分析

目的:分析64排螺旋CT检查在甲状腺癌临床诊断中的应用价值。方法:选取2014年4月至2017年4月本院收治的疑似甲状腺癌患者46例,所有患者均接受64排螺旋CT检查,同时以手术治疗或病理检查为金标准,评估64排螺旋CT检查在甲状腺癌诊断中的应用价值。结果:46例患者中手术或病理确诊34例(73.91%)甲状腺癌,64排螺旋CT确诊30例(65.22%),其诊断准确性84.78%(39/46)、敏感性88.24%(30/34)与特异性75.00%(9/12);64排螺旋CT检查对乳头状癌、滤泡状癌、髓样癌、未分化癌等鉴别诊断结果与手术或病理检查结果相比,差异无统计学意义(P>0.05)。结论:64排螺旋CT检查具有较高的诊断准确性及灵敏度,可作为临床诊断甲状腺癌的有效辅助手段,以节省诊疗时间,提升诊断针对性,改善患者预后。     

外科治疗分化型甲状腺癌50例分析

目的 研究分化型甲状腺癌的手术方式及疗效.方法 回顾分析50例分化型甲状腺癌患者的临床诊治经过及术后随访资料.结果 50例均行甲状腺切除术.手术后随访时间1～10 a,中位随访时间5 a.总的5 a生存率为95％,10 a生存率为90％.结论 手术切除是治疗分化型甲状腺癌的主要方法；选择适当的手术方式可避免术后短期内再手术；对局部复发病灶进行再手术治疗,仍可获得良好的效果.     

包含分化型甲状腺癌的双原发恶性肿瘤患者临床特征及生存分析

目的 分析包含分化型甲状腺癌的双原发恶性肿瘤患者的临床病理特征,探讨其死亡的影响因素。方法 包含分化型甲状腺癌的双原发恶性肿瘤患者71例,2种原发肿瘤诊断中位间隔时间为19.50(5.93,43.43)个月。对甲状腺癌,行甲状腺全切术或次全切术,术后口服¹³¹I清除残留甲状腺组织,¹³¹I累积剂量3.70～17.76 GBq,并应用左旋甲状腺素抑制促甲状腺激素;对另1原发恶性肿瘤,根据相应治疗指南行根治性手术联合放、化疗等规范治疗。随访至2021年12月31日,记录患者生存及末次疗效评估时¹³¹I治疗缓解情况,将患者分为生存组和死亡组;比较2组男性、另1原发恶性恶性肿瘤类型、分化型甲状腺癌诊断年龄≥60岁、2种原发恶性肿瘤诊断间隔时间≥2年、分化型甲状腺癌首发、远处转移、¹³¹I累积剂量≥7.40 GBq、¹³¹I治疗缓解比率;多因素Cox回归分析包含分化型甲状腺癌的双原发恶性肿瘤患者死亡的影响因素。结果 末次随访时¹³¹I治疗缓解率为81.69%,71例...     

分化型甲状腺癌手术治疗204例

分化型甲状腺癌发病率近年来有增高趋势。尽管其生物学特性较好,目前最理想的治疗手段仍然是手术切除。规范的初次手术是影响患者预后的主要因素。以往在分化型甲状腺癌的治疗上一直存在治疗不足或治疗过度两方面的问题,随着对其生物学特性的深入研究,手术方式也相应有了很大改进。自1994年2月至2010年12月共收治分化型甲状腺癌204例,现将其诊断和手术治疗结果报道如下。一、资料与方法1.临床资料:本组共施行分化型甲状腺癌手术治疗204例。其中,男76例,女128例,年龄16～76岁,平均(44.4±16.2)岁。术前细针穿刺细胞学检查确诊61例,术中冰冻快速切片病理确诊143例。     

分化型甲状腺癌术后^131I加替代治疗的疗效观察

目的观察分化型甲状腺癌术后行^131I加替代治疗的临床应用价值。方法对56例术后证实为分化型甲状腺癌的患者采用^131I加替代治疗,随访3-5年。结果56例分化型甲状腺癌患者经治疗后,完全清除残留甲状腺44例,不完全清除12例,其中1例发现新的转移灶。结论分化型甲状腺癌术后采用^131I加替代治疗,能够降低分化型甲状腺癌复发、转移率,有较好的近期疗效。     

桥本病合并甲状腺癌的诊治体会

目的探讨桥本病合并甲状腺癌的诊断和治疗方法。方法回顾我院1993年1月至2008年6月期间112例桥本病合并甲状腺癌14例,分析两者之间的发病机制和诊治经验。结果本组患病率为12．50％（14／112）。全组病人均出现甲状腺结节,14例病人术后随访平均5年,局部复发1例,再次手术现存活;死亡1例,为远处转移。结论桥本病并发甲状腺癌肿术前确诊率低,病史、细针针吸活检、CT等综合分析有利于术前诊断,手术是其最有效的治疗方法。     

B超诊断甲状腺癌的临床价值探讨

甲状腺肿瘤临床诊断的关键在于判断其内结节是否为癌瘤,而甲状腺癌在临床上常难以确诊。近年来随着超声高频技术的发展,使甲状腺的细微结构得以显示,超声诊断已成为临床诊断甲状腺癌的首选方法之一,倍受临床重视。现将我们用高频超声诊断甲状腺癌的临床价值作一分析和探讨。１资料与方法 本组９６例均为我院住院患者,经手术及病理证实为甲状腺癌,男２４例,女７２例,年龄最小１４岁,最大７９岁。乳头状腺癌６７例,滤泡状腺癌１６例,髓样癌５例,未分化癌５例,类癌２例,鳞癌１例。甲状腺癌合并结节性甲状腺肿者２２例,２７例于…     

甲状腺显示胸腺样分化的癌2例临床病理观察

目的探讨显示胸腺样分化的癌(CASTLE)的临床病理学特征、诊断与鉴别诊断、治疗与预后。方法分析2例显示胸腺样分化的癌的临床表现、组织形态学及免疫组化特征,并进行观察及文献复习。结果临床主要表现为颈部肿块,肿物活动度差、质硬,与周围组织界限不清。镜下肿瘤细胞成片状、巢状、岛状排列,肿瘤细胞间常伴有淋巴细胞浸润,颇像原发于甲状腺的鳞状细胞癌。免疫组化:肿瘤细胞CK、CD5、CD117和bcl-2均(+)。结论CASTLE是一种低度恶性肿瘤,非常少见,常常被误诊为发生于甲状腺的鳞状细胞癌,故将两者鉴别开来十分必要。     

甲状腺呈胸腺样分化癌临床病理分析

目的 探讨甲状腺显示胸腺样分化癌(CASTLE)的临床病理特征、免疫表型和鉴别诊断.方法 对2例甲状腺CASTLE进行临床资料分析、随访、病理形态学观察、免疫组化及原位杂交检测,并结合文献进行讨论.结果 2例CASTLE均为女性,分别为27岁和40岁,肿块位于甲状腺下极.巨检:肿瘤灰白色,实性.镜检:肿瘤细胞呈多边形或鳞状上皮样,具有空泡状核,核仁清楚,排列成片块状、巢状或条索状,常见丰富的小淋巴细胞浸润以及纤维组织间质. 例1肿瘤侵犯至甲状腺外软组织.肿瘤细胞CD5、HCK和CD117(+),部分CEA(+),TTF-1、TG、CT和CD21(-);间质淋巴细胞TdT(-).原位杂交EBV(-).分别于术后4个月、9个月对2例进行随访,未见复发或转移.结论 CASTLE是发生于甲状腺或颈部软组织的一种少见肿瘤,多数病例预后良好.需要与转移性鼻咽癌或淋巴上皮样癌、甲状腺鳞状细胞癌和间变性癌、异位胸腺瘤、滤泡树突状细胞肿瘤等相鉴别,免疫组化检测CD5、CD117、EMA和CD21有助于鉴别诊断.     

保留髋臼杯方法在全髋关节翻修术中的应用评价

目的探讨保留髋臼杯更换聚乙烯衬垫在全髋关节翻修术中的应用效果及评价。方法对2008-02—2010-02在我院行髋关节翻修术患者80例(90髋)进行保留髋臼杯更换聚乙烯衬垫治疗,并随访3年,评价髋关节Harris和MOMAC评分及对其疗效进行分析。结果术前Harris髋关节评分(70.09±4.9)分,终末随访(89.4±11.2)分;术前MOMAC评分(56.2±2.1)分,终末随访(41.2±2.1)分。其中脱位2髋,感染1髋,假体周围骨折1髋,衬垫脱落1髋。1例再次翻修为髋臼杯翻新。结论保留髋臼杯手术时间短、并发症少、修复效果可靠。     

甲状腺胸腺样分化癌临床病理观察

目的探讨甲状腺胸腺样分化癌(CASTLE)的临床病理特征。方法对1例甲状腺GASTLE进行临床病理和免疫组化分析,并结合文献讨论其诊断与鉴别诊断。结果甲状腺CASTLE为灰白色实性分叶状肿块;镜下肿瘤由纤维组织条索状分割或呈不同大小的巢块,纤维间隔中有淋巴细胞及浆细胞浸润;肿瘤细胞呈多边形,胞界不清,泡状核,核仁突出,可发生鳞状细胞分化;免疫组化肿瘤细胞表达CD5及CD117。结论甲状腺CASTLE是一种少见的甲状腺恶性肿瘤,发生于中老年人,组织学上与胸腺癌类似,应与甲状腺未分化癌、鳞状细胞癌、转移性淋巴上皮瘤样癌等鉴别,免疫组化示CD5和CD117( )有助于诊断。     

Testicular neuroblastoma

We report a case of isolated intratesticular neuroblastoma in a 17-year-old boy with a history of recurrent metastatic neuroblastoma. He had undergone multiple cycles of chemotherapy, and at the time of our examination was apparently disease-free. Testicular metastases are not uncommon in patients with active metastatic neuroblastoma, but isolated testicular involvement is rare. In this case, ultrasound follow-up allowed early diagnosis and prompt treatment of the testicular lesion. At the 18-month follow-up visit, the patient remains disease-free.     

Multimodal management of lateral epicondylalgia in rock climbers: a prospective case series

Objective

The purpose of this prospective case series was to describe the outcomes of a set of rock climbers with lateral epicondylalgia (LE) treated with manual therapy directed at the cervical spine, elbow, and wrist as well as trigger point (TrP) dry needling and kinesio tape.

Methods

Nine consecutive rock climbers presenting to physical therapy with a diagnosis of LE were included. At baseline, all patients completed the Patient-Rated Tennis Elbow Evaluation and underwent pain pressure threshold testing over the extensor carpi radialis, extensor carpi brevis, brachioradialis, and supinator muscles at baseline, after the third visit (week 3), and at 2-month follow-up. Treatment included manipulation of the cervical spine, mobilization with movement directed at the elbow, manipulation of the wrist, TrP dry needling, and kinesio tape.

Results

Of the 9 subjects who participated in this study, 3 were women (33%), and the mean duration of symptoms was 3 weeks, with an SD of 1.7 weeks (median, 2 weeks; range, 1-6 weeks). There was an improvement in all outcome measures at both the final visit and 2-month follow-up period.

Conclusions

This group of rock climbers with LE who were conservatively managed with a treatment approach consisting of cervical spine manipulation, mobilization directed at the elbow and wrist, and TrP dry needling as well as kinesio tape exhibited clinical improvement.     

小儿淋巴结节细胞神经瘤1例报告并文献复习

目的:探讨淋巴结节细胞神经瘤的起源及诊断、治疗方法。方法:回顾分析1例发生在小儿淋巴结的节细胞神经瘤的临床病理资料,结合文献对其发病情况、生物学特性、临床、病理诊断及手术原则进行讨论。结果:病理诊断为淋巴结节细胞神经瘤。术后恢复顺利。随访2 a,患儿健康,无肿瘤复发。结论:该病例可能为异位性肿瘤,CT及M R I对术前诊断有一定价值,确诊有赖于病理及肿瘤的临床生物学行为表现。完全切除肿瘤,预后良好。     

慢性乙型病毒性肝炎门诊患者复诊依从性及影响因素调查研究

目的探讨影响慢性乙型病毒性肝炎门诊患者复诊依从性的相关因素。方法通过问卷调查和就诊记录采集患者一般情况、有无纳入随访系统及抗病毒时间等资料,并统计所有患者2年来理论就诊时间间隔与实际就诊时间间隔的差值。复诊依从性=实际就诊时间间隔-理论就诊时间间隔,依从性良好定义为复诊依从性8周。结果纳入随访系统的患者复诊依从性明显高于未纳入随访系统的患者(P0.05)。未纳入随访系统的患者中,依从性良好组患者在居住地、文化背景及抗病毒时间与依从性差组比较,差异有统计学意义(P0.05),但多因素分析未提示显著影响因素。在纳入随访系统的患者中,单因素分析与多因素分析都提示依从性良好组患者与依从性差组患者仅在居住地项目上差异有统计学意义(P0.05)。结论纳入随访,进行规律依从性教育可以显著提高患者复诊依从性。居住地与就诊医院距离遥远是影响复诊依从性的危险因素,对于这部分患者应加强复诊依从性教育。     

Microscopic removal of type Ⅲ dens invaginatus and preparation of apical barrier with mineral trioxide aggregate in a maxillary lateral incisor:A case report and review of literature

BACKGROUND Invaginated teeth pose greater challenges in clinical management because of their complex configuration.With advancements in equipment and materials,such as the dental operation microscope,cone-beam computed tomography and mineral trioxide aggregate,the preservation rate of type Ⅲ dens invaginatus could be greatly increased.CASE SUMMARY This case report presented a 31-year-old woman with complaints of spontaneous swelling and pain in the right maxillary lateral tooth.With the aid of cone-beam computed tomography,type Ⅲ dens invaginatus with apical periodontitis was diagnosed and confirmed.Three-visit endodontic treatment was performed.In the first visit,the invagination was carefully removed under the dental operation microscope,and chemomechanical preparation was done.In the second visit,mineral trioxide aggregate apical barrier surgery was performed in this tooth.In the third visit,the canal was finally obturated with thermoplastic gutta-percha to recover the crown morphology.A 26-mo follow-up revealed a satisfied outcome both in the radiographic and oral examinations.CONCLUSION In this case,removal of the entire abnormal structure provided great convenience for the follow-up treatment.When confronted with the same clinical case in the future,we can take a similar approach to address it.     

Obtaining event status at the close of the Treatment of Mild Hypertension Study: methods and implication for other trials

The Treatment of Mild Hypertension Trial was a randomized, double-blind clinical trial conducted from 1986 to 1992 comparing the efficacy of six antihypertensive treatment regimens in 902 participants with stage I hypertension. To satisfy a secondary objective of the study, follow-up information on mortality and cardiovascular morbidity was collected. For this objective the aim was to ascertain the vital and cardiovascular event status as of the last day of the trial. This was accomplished by inviting each participant to attend a closeout visit shortly after the closeout date. In addition to serving as verification of vital status, this visit allowed data collection on nonfatal events that occurred between the last clinic visit and the closeout date. During this visit the patient was unblinded to study medication and given a medical summary of their participation during the trial, as well as a bottle of open-label medication. The advantages of a closeout visit are discussed along with a call for studies to provide clearer definitions of lost to follow-up and censoring times used in life-table analyses, especially when the primary event includes both fatal and nonfatal events. Control Clin Trials 2001;22:56-61