胆囊息肉样病变203例临床分析

目的　探讨胆囊息肉样病变 (PLG )的临床若干问题 ,提高其诊疗水平。方法　腹部B超检出胆囊息肉样病变患者 2 0 3例 ,其中 3 0例经腹腔镜或剖腹胆囊摘除术 ,对其临床表现与病理特点进行比较。结果　 3 0例患者中男性 12例 ,女性 18例 ,年龄 2 8～ 62岁 ,平均年龄 3 8岁。有症状者 16例 ,占 5 3 .3 3 %。真性肿瘤 5例 ( 16.66% ) ,息肉样病变 2 5例 ( 83 .3 3 % ) ,胆囊增厚 18例( 60 .0 % ) ,合并结石者 4例 ( 13 .3 % )。结论　胆囊息肉样病变属胆囊良性肿瘤 ,但少数有恶变危险 ,建议对单发性胆囊息肉样病变直径≥ 10mm或多发性的直径≥ 12mm、直径 <10mm ,但胆囊壁显著增厚 ( >4mm)及 (或 )伴有结石、有较明显的临床症状和B超动态检查息肉短期增大者应手术治疗。     

胆囊息肉样病变直径对判断息肉性质的价值分析*

目的 探讨胆囊息肉直径对判断息肉性质的价值。方法 2010年1月～2019年3月我科诊治的胆囊息肉患者420例,接受开放或腹腔镜胆囊切除术治疗。采用多因素Logistic回归分析胆囊癌发生的危险因素,绘制受试者工作特征曲线(ROC曲线),计算不同胆囊息肉直径预测息肉恶变的曲线下面积(AUC)、敏感性和特异性。结果 经术后组织病理学检查,诊断良性胆囊息肉388例,恶性胆囊息肉32例;良性胆囊息肉患者年龄为(46.6±8.7)岁,显著小于恶性胆囊息肉患者;良性胆囊息肉直径为6(2,27)mm,显著小于恶性胆囊息肉直径;良恶性息肉患者性别构成、胆囊息肉数目、胆囊结石、癌胚抗原、CA19-9和空腹血糖等均无显著性统计学差异(P>0.05);经多因素分析,发现胆囊息肉直径是胆囊癌发生的独立危险因素(P<0.05,OR=1.52,95%CI:1.36～1.69);绘制胆囊息肉直径ROC曲线,得出AUC为0.89(0.85～0.93),即当息肉直径为13 mm时,诊断胆囊癌的敏感性和特异性分别为91.0%和71.8%。结论 胆囊息肉直径预测胆囊癌的价值较高,当息肉直径>13 mm时,因恶变风险增大,建议手术治疗。     

胆囊息肉样变的M值临床意义

目的:探讨根据胆囊息肉样变的超声影像学特征计算得到的M值对胆囊息肉样变临床诊断和治疗的指导意义.方法:收集2011-01/2013-12收治的114例胆囊息肉样变患者临床资料,记录所有患者术前超声的影像学特点:大小、部位、单发或多发、蒂是否宽大、回声强度、胆囊壁是否增厚、息肉样病变边缘是否光滑等,按照M值公式(M=0.02×年龄+0.31×X1+0.9×X2+0.15×X3-5.5)计算得出M值,并结合术后病理分型进行统计学分析.结果:术后经病理诊断为不同类型胆囊息肉或胆囊癌114例,其中胆固醇性息肉79例(69.30%),炎症息肉14例(12.28%),胆囊腺肌增生症3例(2.63%),腺瘤性息肉4例(3.51%),腺瘤恶变4例(3.51%),胆囊癌10例(8.77%);M<0者93例(81.58%);均为良性病变;0≤M<2.5者7例(6.14%),4例良性病变,2例癌前病变,1例恶性病变;M≥2.5者14例(12.28%),13例恶性病变,1例癌前病变.M值与病理分型具有正相关关系(r=0.881,P<0.001),即M值越大,胆囊息肉样变可能为恶性的程度越高.,结论:通过M值可初步预测胆囊息肉样变的良恶性,对其临床诊断和指导治疗具有重要意义.     

胆囊息肉样病变的彩色多普勒超声诊断价值

目的 探讨彩色多普勒超声对胆囊息肉样病变的诊断价值，以期获得胆囊息肉样病变不同病理类型的声像图特征，为早期诊断提供依据。方法 分析36例胆囊息肉样病变（胆固醇性息肉23例、胆囊腺肌增生症5例、腺瘤4例、早期胆囊癌4例）的彩色多普勒超声特征。结果 胆固醇性息肉及腺肌瘤样增生病灶直径多〈1cm，腺瘤及早期胆囊癌直径多1cm。RI〉0．6可作为判断恶性病变的标准。结论 彩色多普勒超声诊断对胆囊息肉的诊断和鉴别诊断有重要价值。     

胆囊小息肉样病变的手术指征

胆囊息肉样病变中大多数是胆固醇息肉,超声诊断胆囊息肉的特异性为93.9％,是鉴别良恶性病变的有用手段。但术前早期诊断胆囊癌仍比较困难。因此需要探寻更精确地区分良、恶性息肉样病变的方法。     

胆囊息肉样病变612例临床分析

目的分析总结胆囊息肉样病变的临床、病理、诊断等特征．方法我院及中华医学会第七届全国胆道外科学术会议资料共报道胆囊息肉样病变６１２例进行分析和总结．结果胆囊息肉样病变６１２例占同期胆囊切除术的４２％；３０岁～５０岁占７８５％；结石合并率２８５％；病理类型中以胆固醇息肉最多，占５３７％；腺瘤性息肉恶变率极高，达２８５％；临床表现无特异性，Ｂ超的诊断率最高，达９２５％．结论胆囊息肉样病变患者相对年轻；病理类型以胆固醇类多见，腺瘤性息肉易恶变，特别是合并结石的息肉；临床诊断以Ｂ超为首选     

新疆地区胆囊息肉样病变331例临床分析

目的对胆囊息肉样病变(PLG)的临床特征进行分析,并探讨手术切除指征。方法对2008年8月-2013年12月新疆医科大学第四附属医院331例住院已经手术的PLG患者资料进行回顾性分析。组间率的比较采用卡方检验。结果 331例手术病例中,肿瘤性息肉13例(3.9%),非肿瘤性息肉318例(96.2%);将肿瘤组与非肿瘤组的临床特征进行对比,发现性别(χ2=6.2,P=0.013)、年龄(≥40岁/40岁)(χ2=3.90,P=0.048)、息肉大小(≥10 mm/10 mm)(χ2=77.4,P0.000 1)、病灶数目(多发/单发)(χ2=6.2,P=0.013)、息肉基底宽度(≥6 mm/6 mm)(χ2=111.8,P0.000 1)、是否合并胆囊结石(χ2=7.5,P=0.006)在2组间分布差异具有统计学意义。结论症状是决定手术指征的一个单独因素,有症状即应手术。大多数胆囊息肉恶变率低,年龄≥40岁、直径≥10 mm的单发息肉、息肉基底宽≥6 mm、近期增大明显、息肉合并结石等肿瘤相关因素,也是胆囊切除的手术指征。     

胆囊息肉样病变恶变危险因素的Meta分析

目的通过Meta分析评价胆囊息肉样病变恶变的危险因素,探讨预防性胆囊切除术的手术指征。方法根据纳入标准,摘录15篇病例对照研究文献中有关实验研究设计、研究对象特征、研究结果等内容,评价文献质量后,采用RevMan5.0软件进行分析。结果女性、年龄〉50岁、病变大小≥10 mm、单发病变、无蒂息肉、伴随临床症状的病变、合并胆囊结石7个研究因素的合并比值比（OR值）分别为1.51、7.27、54.65、6.34、15.79、2.37、2.57。结论胆囊息肉样病变恶变的危险因素为（1）女性;（2）年龄〉50岁;（3）病变大小≥10 mm;（4）单发病变;（5）无蒂息肉;（6）伴随临床症状的病变;（7）合并胆囊结石的病变。     

胆囊息肉样病变的癌变危险因素分析

目的探讨胆囊息肉样病变（PLG）的癌变危险因素。方法选择118例行手术治疗且经病理证实的PLG患者,对其临床特征、腹部超声表现及病理类型进行统计分析。结果118例PLG患者中,男女比例为1：2．03,平均年龄46．2岁,临床多无特异性症状;腹部超声诊断PLG的灵敏度为80．5％。PLG以非肿瘤性息肉为主,其中胆固醇性息肉占72．9％;肿瘤性息肉占9．3％,其中癌变1例（癌变率为0．8％）;118例PLG患者的平均息肉直径为7．86rain,息肉直径≥7mm者肿瘤性息肉占90．9％、非肿瘤性息肉占54．2％（P〈0．05）。肿瘤性息肉中单发者占63．6％,非肿瘤性息肉者占24．3％（P〈0．05）。结论PLG以胆固醇性息肉为主;年龄≥50岁、息肉直径≥7mm、单发或腹部超声表现为中低或等回声的PLG癌变可能性较大,应密切随访,观察息肉变化情况,必要时行外科手术治疗。     

胆囊息肉样病变的自然史

胆囊息肉样病变常见于无症状患者。本研究首次用超声检查法对胆囊息肉样病变的自然史进行了研究。 方法:1988年4343例门诊患者中B超检查发现111例有胆囊息肉样病变,其中2例有胆囊癌,其余109例列人观察。以后B超随访每年1～2次,共5年,记录息肉数目与最大息肉的直径。胆囊息肉样病变的诊断标准为,由囊壁突向囊腔的无声影不移动的回声。 结果:61%患者有多个息肉样病变,39%为     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.