3种恶性成分的腮腺区多形性腺瘤癌变1例报告及文献复习

目的：探讨1例含有3种恶性成分的腮腺区多形性腺瘤癌变（CXPA）患者的诊断和预后,提高临床医生对该病的认识。方法：患者因左腮腺区肿物30年余伴疼痛1个月入院,经腮腺区彩超检查后行左腮腺区肿物切除术。结果：该患者手术过程顺利,术后病理诊断为CXPA,包含非特异性腺癌、导管癌和肌上皮癌3种恶性成分。结论：同时含有多种恶性成分的CXPA临床罕见,诊断困难,预后差,临床医师应提高对该病的认识。     

不同分型的涎腺多形性腺瘤组织中血管内皮生长因子、核转录因子p50的表达及意义

目的探讨血管内皮生长因子(VEGF)、核转录因子(NF-κB)p50在不同分型涎腺多形性腺瘤中的表达及意义。方法本研究收集河北联合大学附属医院和开滦总医院2007年3月~2012年6月50例涎腺多形性腺瘤组织石蜡标本,采用免疫组化染色方法 SP法检测50例涎腺多形性腺瘤(基质丰富型25例为A组、细胞丰富型25例为B组)中VEGF、NF-κB p50的表达情况,并与瘤旁涎腺组织(对照组)25例的表达情况做对比分析。结果 VEGF在A组的积分光密度(IOD)值为(153.13±60.81);B组的IOD值为(954.65±305.79);对照组的IOD值为(52.46±9.76),A、B组均较对照组增高,B组较A组增高,组间比较差异均有统计学意义(均P<0.05)。NF-κB p50在A组的IOD值为(43.40±5.56);B组为(529.79±163.81);对照组为(6.83±1.90),A、B组均较对照组增高,B组较A组增高,组间比较差异均有统计学意义(均P<0.05)。结论细胞丰富型涎腺多形性腺瘤组织中VEGF、NF-κB p50较基质丰富型涎腺多形性腺瘤均有更高的表达,VEGF、NF-κB p50的检测对鉴别涎腺多形性腺瘤的不同分型及指导临床诊断和治疗均有帮助。     

A hospital-based study of splenomegaly with special reference to the group of indeterminate origin

In any study there remains a proportion of cases, about 25-40%, where cause of splenomegaly is not identified on usual evaluation, that is labelled as indeterminate group. The aim of this study was to evaluate various causes of splenomegaly. Thereafter the patients with splenomegaly of indeterminate origin were to be re-evaluated with detailed investigations (for the cause of splenomegaly). Causes of splenomegaly were looked into 100 adult patients with splenomegaly, admitted over a period of ten months in a teaching hospital in South India. Patients having ascites were excluded from the study. Malaria was the commonest cause of splenomegaly, observed in 22 patients. Other causes, in order of importance, were chronic myeloid leukaemia (n=11), non-cirrhotic portal fibrosis (n=9), enteric fever (n=9), cirrhosis of liver (n=8) and hyper-reactive malarial splenomegaly also called as tropical splenomegaly syndrome (n=7) and so on. Hyper-reactive malarial splenomegaly was the commonest cause (7 of 24 patients) of massive splenomegaly. Twenty-three patients had splenomegaly of indeterminate origin ie, cause could not be detected on first assessment. Detailed re-evaluation with repeat investigations including liver biopsy revealed the causes as follows: Hyper-reactive malarial splenomegaly -7 (30.4%), non-cirrhotic portal fibrosis - 4 (17.4%), cirrhosis of liver - 4 (17.4%) and iron deficiency anaemia - 5 (21.7%). In 3 patients (13.0%), no diagnosis could be arrived at despite best efforts. Obscure splenomegalies may be due to conditions like hyper-reactive malarial splenomegaly, non-cirrhotic portal fibrosis, iron deficiency anaemia, and even cirrhosis of liver, while malaria is still the most important cause of splenomegaly in India. Whereas the overall incidence of hyper-reactive malarial splenomegaly was only 7% in this study, it stood as the leading cause (29.2%), when analysed among patients with massive splenomegaly. Liver biopsy should be performed in all cases of obscure splenomegaly to arrive at the final diagnosis.     

唾液腺核素动态成像在干燥综合征诊断中的应用

目的：观察唾液腺核素动态成像在干燥综合征中的成像特点,探讨其在干燥综合征诊断中的价值。方法：对干燥综合征患者组和正常对照组行唾液腺核素扫描动态成像检测。首先对患者组腮腺和颌下腺成像阳性率进行比较。其次比较患者组和对照组分别在腮腺、颌下腺核素摄取速率和排泄速率的差异。结果：①干燥综合征患者组中腮腺和颌下腺核素扫描动态成像的阳性率无统计学差异（P〉0.05）;②患者组腮腺和颌下腺的核素摄取速率和排泄速率均显著高于正常对照组。结论：唾液腺核素扫描动态成像为干燥综合征临床诊断提供了有力的手段。     

以不明原因发热起病的恶性肿瘤65例临床分析

目的 探讨不明原因发热与恶性肿瘤的关系。方法 对以不明原因发热起病的肿瘤患者进行病史分析、肿瘤标记物检测、影像学检查和组织病理学检查。结果 以不明原因发热起病的65例恶性肿瘤中，血液系统恶性肿瘤29例，占44．6％；消化系统肿瘤27例，占41．5％，其中原发性肝癌19例，占29．2％；肺癌6例，占9．2％。结论 恶性肿瘤是引起不明原因发热的主要病因之一，尤其以血液系统及消化系统恶性肿瘤为多见，及时有效地进行相关肿瘤的检查，可明确诊断。     

肘关节恐怖三联征的分类亚型及临床意义

目的 肘关节恐怖三联征除了X片可见的后脱位和桡骨头及尺骨冠突骨折外,还有广泛的软组织损害.本文根据肘关节内侧副韧带(MCL)损伤如否,将肘关节恐怖三联征分为2个亚型并探讨其临床意义.方法 2004-2009年,共治疗7例肘关节恐怖三联征,其中Ⅰ型2例(MCL完整)保守治疗,石膏固定2~3周后功能锻炼;Ⅱ型5例(MCL断裂)手术治疗,经内外侧双切口显露,分别固定桡骨头和冠突,修复外侧副韧带和内侧副韧带.结果 7例患者获得1~4年随访(平均2年).骨折愈合,肘关节稳定,活动无疼痛.活动幅度屈伸平均120°,旋转100°,MEPS评分优5例,良2例.结论 在肘关节恐怖三联征中,MCL完整者,其桡骨头和冠突骨折的类型和移位均较轻,可保守治疗;MCL断裂者,其骨折类型和移位均较重,需手术治疗.修复MCL能显著提高肘关节的稳定性.