宫腔镜在异常子宫出血诊断中应用分析

目的探讨宫腔镜在异常子宫出血诊断中应用。方法采取宫腔镜对异常子宫出血诊断患者102例与取材标本病理进行对比,了解宫腔镜检查与病理诊断符合率。结果宫腔镜检查子宫内膜息肉诊断与病理诊断符合率为94.73%,宫腔镜检查子宫内膜增生诊断与病理诊断符合率为54.54%,宫腔镜检查正常子宫内膜诊断与病理诊断符合率为63.33%,子宫黏膜下肌瘤诊断与病理诊断符合率为82.35%,妊娠相关疾病诊断与病理诊断符合率为71.43%,子宫内膜癌诊断与病理诊断符合率为100%。结论宫腔镜在异常子宫出血诊断中具有高度特异性,显著提高诊断率,降低误诊率,是诊断宫腔内病变的金标准。     

磁共振成像对Ⅰ、Ⅱ期子宫内膜癌的诊断价值

子宫内膜癌是女性生殖系统最常见的恶性肿瘤之一,治疗前对病变的准确分期有助于临床合理选择治疗方案及评估预后.MRI作为一种无创伤且具有极高软组织分辨率的检查方法,在子宫内膜癌术前诊断中的应用越来越多.笔者回顾分析经手术病理证实的Ⅰ、Ⅱ期子宫内膜癌32例,将其病理结果与术前MRI检查作一对比分析,以期总结子宫内膜癌的MRI表现及MRI对子宫内膜癌分期诊断的准确性.     

子宫动脉栓塞术用于胎盘植入性疾病

胎盘植入性疾病(PAS)属于产科危急重症,可致围产期难治性大出血、失血性休克、弥漫性血管内凝血,剖宫产手术出血量、输血量、子宫切除率及死亡率均较高。子宫动脉栓塞术(UAE)用于治疗PAS可有效栓塞子宫动脉主干及其分支,减少手术出血量及输血量,降低子宫切除率。本文对UAE用于PAS进展进行综述。     

经阴道彩色多普勒超声对子宫内膜癌的诊断价值

目的 探讨子宫内膜癌的彩色多普勒超声表现.方法对22例经阴道彩色多普勒超声诊断的子宫内膜癌病例与术后结果进行分析比较,并对其诊断价值作出临床评价.结果经阴道彩色多普勒超声诊断疑似子宫内膜癌病例22例,经手术及病理证实的子宫内膜癌16例,正确率72.7%,其余3例经病理证实为子宫内膜增殖症,1例为子宫内膜炎,1例为子宫内膜息肉,还有1例为粘膜下肌瘤伴感染.结论经阴道彩色多普勒超声对子宫内膜癌有较高的诊断价值.     

宫腔镜检查诊断绝经后子宫出血的价值

目的 探讨宫腔镜检查对绝经后出血的诊断价值.方法 采用美国Stryker公司电视宫腔镜对120例绝经后出血行宫腔镜检查,行诊断性刮宫或直视下取活检,组织送病理.结果 宫腔镜检查120例分别为萎缩性子宫内膜58例,子宫内膜息肉19例,子宫肌瘤17例,子宫内膜增生9例,宫颈息肉8例,子宫内膜炎3例,子宫内膜癌2例,宫内节育器4例,与病理诊断的符合率分别为100%(58/58)、94.7%(18/19)、88.2%(15/17)、81.8%(9/11)、100%(8/8)、60.0%(3/5)、66.7%(2/3).结论 宫腔镜检查是寻找绝经后出血原因的有效方法,结合病理可提高诊断的准确性.     

产褥期子宫血管瘤误诊为宫内残留1例

目的探讨产褥期子宫血管瘤的临床病理特点。方法通过对1例误诊为宫内残留的产褥期子宫血管瘤的临床病理特点进行观察分析。结果子宫血管瘤临床表现无特异性,且症状不典型,导致临床诊断出现困难,确诊需要依赖病理检查,盆腔动脉栓塞术是治疗子宫血管瘤安全有效的保守方法。结论产褥期子宫血管瘤为罕见的良性肿瘤,容易误诊、漏诊对生命造成威胁,增强CT和MRI可提高对子宫血管瘤的术前诊断,对于有生育需求的患者,应在明确诊断后早期尽早行子宫动脉栓塞术。     

彩超对18例子宫绒毛膜癌的研究

目的:探讨彩超对子宫绒毛膜癌的诊断应用价值.方法:本文回顾性分析18例经手术病理证实子宫绒毛膜癌患者的彩色血流显像(CDFI)及脉冲多普勒(PW)超声检查特点.结果:子宫绒毛膜癌具有较典型的二维图像特征,子宫动脉呈相对较高的RI;病灶区域血流丰富等特点.结论:彩超对子宫绒毛膜癌具有较高诊断价值,为妇科早期诊断绒癌提供了可靠的诊断依据.     

高频超声对腹壁切口子宫内膜异位症的诊断价值

目的 通过分析腹壁子宫内膜异位症的超声声像图特征,探讨高频超声对剖宫产或妇科手术后腹壁子宫内膜异位症的诊断价值. 方法 对高频超声诊断的41例腹壁切口子宫内膜异位症患者的检查结果与术后病理结果做对比分析,评价高频超声在腹壁切口子宫内膜异位症术前诊断中的应用价值. 结果 术前超声诊断提示腹壁切口子宫内膜异位症的患者在术后得到病理学证实的有37例,超声术前诊断准确率为90.2％. 结论 高频超声在术前对腹壁切口子宫内膜异位症的诊断准确率较高,且安全、无创、重复性好,有很好的临床应用价值.     

手术切口瘢痕子宫内膜异位症16例临床分析

目的:探讨手术切口瘢痕子宫内膜异位症的诊断、治疗及预防.方法:对1998年1月至2010年1月在我院就诊的16例手术切口瘢痕子宫内膜异位症患者的临床特点进行回顾性分析.结果:16例患者术后病理检查结果均确诊为切口瘢痕子宫内膜异位症,术后均痊愈出院.结论:手术切口瘢痕子宫内膜异位症应早期诊断,手术治疗是唯一有效的治疗方法,手术中注意保护切口是预防的关键.     

子宫、乳腺、肾多原发癌一例

患者女性,58岁,绝经13年,阴道少量流血半个月,诊刮病理诊断:子宫内膜重度不典型增生,腺癌不能排除.于2007年5月27日入院,于腰麻-硬膜外联合麻醉(CSEA)下行子宫次全切除术+双侧附件切除术,病理诊断:子宫内膜腺癌(图1A),内膜样型,高分化.     

Collecting (Bellini) Duct Carcinoma of the Kidney — Clinical,Radiologic and Immunohistochemical Findings

We present clinical and radiological findings in a case of collecting (Bellini) duct carcinoma (CDC). This is a rare and aggressive kidney cancer originating from the distal renal tubule. The patient underwent radical nephrectomy and the pathological report showed trabeculopapillary, partially solid adenocarcinoma infiltrating the renal capsule and sinus. Immunohistochemical, as well as mucinocarminic and PAS staining studies are necessary for diagnosis of CDC. Surprisingly, one year follow-up studies were negative for recurrent disease. Chromosomal findings are usually different from most often diagnosed clear cell renal cell cancers. Findings from the literature are briefly discussed.     

超声检查新技术诊断胎盘植入性疾病研究进展

胎盘植入性疾病（PAS）早期临床表现隐匿,诊断困难,但产后并发症严重,甚至危及母亲和新生儿生命。以常规超声为基础,联合各种超声检查新技术,可提高PAS早期诊断准确率,有助于临床医师制订合理治疗方案以改善预后。本文对超声检查新技术诊断PAS研究进展进行综述。     

特殊染色技术在艾滋病合并真菌病理诊断中的应用

目的 探讨特殊染色技术在艾滋病合并真菌病理诊断中的应用价值.方法 选取2010年2月至2013年11月上海市（复旦大学附属）公共卫生临床中心确诊为艾滋病合并真菌感染的患者20例,回顾性分析经苏木素-伊红（HE）染色、过碘酸希夫染色（PAS）和六胺银染色的病理资料,观察常见真菌在光镜下的形态.结果 20例艾滋病合并真菌感染的患者中,肺部隐球菌2例,皮肤、肺、腹腔肠系膜淋巴结马尔尼菲青霉菌3例,会厌、颈部淋巴结、口腔、腹腔及皮肤组织胞浆菌5例,上颌窦、肺及声带曲霉4例（合并结核3例）,肝、咽、食道及胃部白色假丝酵母菌6例.HE染色组织中炎性细胞浸润,可见肉芽肿形成,凝固性坏死,真菌形态尚能辨认,但需仔细观察,否则易漏诊或误诊;PAS染色,真菌孢子和假菌丝呈亮丽的紫红色,细胞核紫蓝色;六胺银染色,真菌孢子和假菌丝呈清晰可辨的黑褐色.结论 除常规进行HE染色外,联合应用PAS染色和六胺银染色,有助于提高真菌的病理诊断率.     

阴囊、阴茎Paget病临床病理分析

目的:探讨阴囊、阴茎Paget病的临床病理特点、诊断及鉴别诊断依据。方法:复习13例阴囊、阴茎Paget病的临床病理资料,采用HE染色、特殊染色(AB/PAS)及免疫组化技术进行观察分析。结果:阴囊、阴茎Paget病以老年男性多见,发病年龄55～84岁,中位年龄为71岁。肉眼皮损呈湿疹样改变。光镜下表皮内可见数目不等的Paget细胞呈单个散在、巢状或条索状分布。所有病例AB/PAS染色均阳性;13例均表达CK7、CEA、EMA抗原,不表达CK5/6、S-100及P63,GCDFP-15与CK20阳性表达率分别为76.92%(10/13)和53.85%(7/13)。结论:阴囊、阴茎Paget病为低度恶性的皮肤上皮性肿瘤,有特殊的临床及组织病理学特点,免疫组化标记有助于该肿瘤的诊断。     

Type 1 diabetes and polyglandular autoimmune syndrome: A review

Type 1 diabetes(T1D) is an autoimmune disorder caused by inflammatory destruction of the pancreatic tissue. The etiopathogenesis and characteristics of the pathologic process of pancreatic destruction are well described. In addition, the putative susceptibility genes for T1 D as a monoglandular disease and the relation to polyglandular autoimmune syndrome(PAS) have also been wellexplored. The incidence of T1 D has steadily increased in most parts of the world, especially in industrialized nations. T1 D is frequently associated with autoimmune endocrine and non-endocrine diseases and patients with T1 D are at a higher risk for developing several glandular autoimmune diseases. Familial clustering is observed, which suggests that there is a genetic predisposition. Various hypotheses pertaining to viral- and bacterialinduced pancreatic autoimmunity have been proposed, however a definitive delineation of the autoimmune pathomechanism is still lacking. In patients with PAS, pancreatic and endocrine autoantigens either colocalize on one antigen-presenting cell or are expressed on two/various target cells sharing a common amino acid, which facilitates binding to and activation of T cells. The most prevalent PAS phenotype is the adult type 3 variant or PAS type Ⅲ, which encompasses T1 D and autoimmune thyroid disease. This review discusses the findings of recent studies showing noticeable differences in the genetic background and clinical phenotype of T1 D either as an isolated autoimmune endocrinopathy or within the scope of polyglandular autoimmune syndrome.     

Families as catalysts for peer adherence support in enhancing hope for people living with HIV/AIDS in South Africa

Introduction

Hope is an essential dimension of successful coping in the context of illnesses such as HIV/AIDS, because positive expectations for the future alleviate emotional distress, enhance quality of life and have been linked to the capacity for behavioural change. The social environment (e.g. family, peers) is a regulator of hope for people living with HIV/AIDS (PLWHA). In this regard, the dual aim of this article is (1) to analyze the influence of a peer adherence support (PAS) intervention and the family environment on the state of hope in PLWHA and (2) to investigate the interrelationship between the two determinants.

Methods

The Effective AIDS Treatment and Support in the Free State study is a prospective randomized controlled trial. Participants were recruited from 12 public antiretroviral treatment (ART) clinics across five districts in the Free State Province of South Africa. Each of these patients was assigned to one of the following groups: a control group receiving standard care, a group receiving additional biweekly PAS or a group receiving PAS and nutritional support. Latent cross-lagged modelling (Mplus) was used to analyse the impact of PAS and the family environment on the level of hope in PLWHA.

Results

The results of the study indicate that neither PAS nor the family environment has a direct effect on the level of hope in PLWHA. Subsequent analysis reveals a positive significant interaction between family functioning and PAS at the second follow-up, indicating that better family functioning increases the positive effect of PAS on the state of hope in PLWHA.

Conclusions

The interplay between well-functioning families and external PAS generates higher levels of hope, which is an essential dimension in the success of lifelong treatment. This study provides additional insight into the important role played by family dynamics in HIV/AIDS care, and it underscores the need for PAS interventions that are sensitive to the contexts in which they are implemented.     

原发性前列腺印戒细胞癌诊疗分析

目的 提高对原发性前列腺印戒细胞癌临床特点的认识和诊治水平. 方法 原发性前列腺印戒细胞癌患者23例.年龄57～90岁,平均74岁.有排尿症状者18例,体检偶然发现PSA升高者5例.实验室检查PSA平均45.3(7.4～126.8)ng/ml.MRI多示外周带有异常区呈T1w低信号、T2W高信号,增强后明显强化,中央带见增生结节,呈混杂信号.其中行前列腺癌根治术7例,2例切缘阳性者术后辅以全雄激素阻断治疗及体外放射治疗,16例行全雄激素阻断治疗,其中11例因存在下尿路梗阻而行前列腺绿激光汽化术,3例行体外放射治疗.23例均行消化道内镜或钡餐检查排除转移性印戒细胞癌. 结果 23例均经病理证实为印戒细胞癌,其中纯印戒细胞癌6例,混有典型前列腺癌成分17例,其中典型癌成分均为Gleason评分7～10分的高级别低分化前列腺癌.免疫标记PSA、前列腺酸性磷酸酶均为阳性,AB/PAS阴性,CEA阴性21例.TNM临床分期Ⅱ期7例,Ⅲ期10例,Ⅳ期6例.20例平均随访24(6～56)个月,8例生存6～42个月后因肿瘤转移死亡,5例12～21个月后出现生化复发,失访3例. 结论 原发性前列腺印戒细胞癌侵袭性强、转移快且累及前列腺外各种脏器、复发早,早期诊断及综合治疗或能提高远期生存率.     

Clinicopathological study of clear-cell tumors of the thyroid: An evaluation of 22 cases

Twenty-two cases of partial or wholly composed clear-cell thyroid tumors were reviewed to differentiate between a primary nodule and metastatic clear-cell renal carcinoma in the thyroid. Pathological reevaluation of HE-stained specimens, immunohistochemical observation using anti-thyroglobulin (TG) antibody, and periodic acid-Schiff (PAS) staining were performed. The pathological characteristics in metastases from the kidney have a greater tendency to demonstrate a strikingly clear cytoplasm with small nuclei, rich vascularization, and a trabecular arrangement of tumor cells than do primary thyroid cases. The immunohistochemical TG staining in conjunction with PAS staining for the recognition of follicular colloid could provide much more reliable information of primary cases compared to that using TG staining alone. Clinically, in primary cases, the female: male ratio is substantially higher while the mean age is lower than in metastatic cases reflecting differentiated thyroid carcinoma. In conclusion, immunohistochemical staining for TG with PAS staining for the recognition of follicular colloid proved to be the most sensitive method for identifying primary clear cell thyroid tumors. In addition, a careful assessment of past and/or present kidney disorders to rule out metastatic renal cell carcinoma is advisable. Age, gender, and physiological findings are also informative when differentiating between them.     

Temporary occlusion of associative motor cortical plasticity by prior dynamic motor training

A novel Hebbian stimulation paradigm was employed to examine physiological correlates of motor memory formation in humans. Repetitive pairing of median nerve stimulation with transcranial magnetic stimulation over the contralateral motor cortex (paired associative stimulation, PAS) may decrease human motor cortical excitability at interstimulus intervals of 10 ms (PAS10) or increase excitability at 25 ms (PAS25). The properties of this plasticity have previously been shown to resemble associative timing-dependent long-term depression (LTD) and long-term potentiation (LTP) as established in vitro. Immediately after training a novel dynamic motor task, the capacity of the motor cortex to undergo plasticity in response to PAS25 was abolished. PAS10-induced plasticity remained unchanged. When retested after 6 h, PAS25-induced plasticity recovered to baseline levels. After training, normal PAS25-induced plasticity was observed in the contralateral training-naive motor cortex. Motor training did not reduce the efficacy of PAS25 to enhance cortical excitability when PAS10 was interspersed between the training and application of the PAS25 protocol. This indicated that the mechanism supporting PAS25-induced plasticity had remained intact immediately after training. Behavioral evidence was obtained for continued optimization of force generation at a time when PAS25-induced plasticity was blocked in the training motor cortex. Application of the PAS protocols after motor training did not prevent the consolidation of motor skills evident as performance gains at later retesting. The results are consistent with a concept of temporary suppression of associative cortical plasticity by neuronal mechanisms involved in motor training. Although it remains an open question exactly which element of motor training was responsible for this effect, our findings may link dynamic properties of LTP formation, as established in animal experiments, with human motor memory formation and possibly dynamic motor learning.     

痔体黏膜发现白色念珠菌寄生

为探讨痔的病因,将26例患者痔体送病理组织检查,PAS染色发现9例有紫红色菌体寄生,据其形态判断是白色念珠菌,试管沙氏培养基培养见奶白色酵母样菌落,转种于科玛嘉培养基培养见菌落呈翠绿色,诊断为白色念珠菌。由此推断痔上皮增生、角化,黏膜大量炎细胞浸润,间质水肿、出血,黏膜下静脉强烈炎性变,是因白色念珠菌感染引起的。