肾原发性类癌临床病理观察

目的 探讨肾原发性类癌的组织学发生、临床病理特征、鉴别及预后.方法 对1例原发于肾的类癌进行光镜、免疫组化和超微结构研究,并复习相关文献.结果 患者男性,46岁.CT显示肿块边界尚清,均质,增强后肿瘤强化不明显.光镜下肿瘤组织呈梁状、缎带状排列,间质富于薄壁血管;肿瘤细胞多边形,胞质嗜酸,细胞界限不清,核圆,核分裂少见.免疫表型:肿瘤细胞Syn、CD99和vimentin( ),CKpan、EMA、CK7、CDl0、P504S、Ksp-cadherin、CDll7、SMA和CD34(-).电镜下肿瘤细胞胞质内见大量神经分泌颗粒,细胞间还可见桥粒结构.结论 肾原发性类癌是一种罕见的肿瘤,诊断主要依据病理形态学检查和免疫组化标记,电镜检查有助于确定诊断.     

喉神经内分泌癌3例报道及文献复习

目的　报道 3例喉原发性神经内分泌癌 ,并探讨其病理学特征及其鉴别诊断。方法　对 3例喉神经内分泌癌进行光镜、电镜观察及免疫组化标记。结果　 3例肿瘤均位于声门上会咽区 ,大体直经 <3cm ,2例呈息肉状。光镜检查 2例肿瘤以巢团状结构为主 ,瘤细胞胞质丰富 ,嗜酸性 ,核分裂象易见 ,有坏死。 1例以小梁状结构为特征 ,瘤细胞较小 ,分裂象罕见 ,无坏死。免疫组化标记显示瘤细胞CgA、Syn、CK(AE1)及NSE( ) ,S 10 0、HMB4 5及GFAP(- )。电镜观察瘤细胞间有细胞连接复合体、细胞内腔及神经内分泌颗粒。结论　喉神经内分泌癌是少见的恶性肿瘤 ,形态学上应当与喉的低分化鳞癌、副节瘤、无色素性黑色素瘤等相鉴别。免疫组化标记及电镜观察对于鉴别诊断很有帮助。     

肺嗜酸细胞腺癌的临床病理观察

目的 探讨肺嗜酸细胞腺癌的临床病理特征。方法 运用光镜、电镜及免疫组化方法观察1例肺嗜酸细胞腺癌并复习相关文献。结果 组织病理学特点：肿瘤无包膜，浸润性生长，明显坏死，瘤组织由含有嗜酸性颗粒胞质的细胞构成，细胞和核显著多形性。免疫组化：CK（＋）、EMA、Syn、CgA和S-100（-）。电镜：瘤细胞胞质内充满大量线粒体，无神经内分泌颗粒。结论 肺嗜酸细胞癌是一种极其少见的恶性肿瘤，形态学上应与肺的嗜酸细胞性类癌、嗜酸细胞腺瘤、转移性嗜酸细胞腺癌等相鉴别，免疫组化染色和电镜观察在该肿瘤的诊断和鉴别诊断中具有重要作用。     

纵隔原始神经外胚层肿瘤伴横纹肌样表型临床病理分析

目的探讨原始神经外胚层肿瘤伴横纹肌样表型的病理特征。方法对1例50岁女性患者的纵隔巨大肿瘤进行光镜、免疫组化及电镜观察。结果肿瘤大小为15 cm×15 cm×16 cm。组织学显示肿瘤细胞小圆形,部分细胞核偏位,胞质内见嗜酸性包涵体。组织化学染色PAS小灶性( )。免疫组化:vimentin、CD99及chromogranin强( ),S-100蛋白( ),EMA小灶性( ),desmin及MyoD1(-)。超微结构:小圆形肿瘤细胞胞质有短钝突起,见原始细胞连接、发育不良桥粒及胞质内致密核心颗粒。一些肿瘤细胞见核旁分布的、呈旋涡状排列的球形微丝小体,线粒体、粗面内质网及脂滴被包裹在其中。结论原始神经外胚层肿瘤伴横纹肌样表型的病理诊断依赖于光镜、免疫组化及电镜检查。     

淋巴组织细胞样间皮瘤临床病理观察

目的探讨淋巴组织细胞样间皮瘤（LHM）的病理诊断、鉴别诊断及预后。方法观察和分析2例LHM的病理形态学特点、免疫组化染色并进行文献复习。结果本文2例LHM均出现胸痛。光镜下见瘤细胞呈圆形、短梭形及梭形,大小不等,弥漫分布。肿瘤组织中见非典型的纤维组织细胞、淋巴细胞、浆细胞及少量嗜酸性粒细胞浸润。电镜下瘤细胞表面见少量较细长的蓬发样微绒毛,胞质内见较多张力微丝。免疫组化示vimentin、calretinin、CK、抗间皮抗原、CD68和EAM均（＋）。结论淋巴组织细胞样间皮瘤是一种少见的特殊类型恶性肉瘤样间皮瘤,其电镜及免疫组化检测有助于诊断。需与恶性淋巴瘤、恶性胸腺瘤及恶性纤维组织细胞瘤等鉴别。     

宫颈毛玻璃样细胞癌4例临床病理分析

目的探讨宫颈毛玻璃样细胞癌(GCC)的临床病理学特点、病理诊断和鉴别诊断及预后。方法对肿瘤标本做常规石蜡切片,行HE染色和免疫组化染色,光镜观察。结果 4例宫颈GCC患者的发病年龄分别为26、26、27和31岁。镜下见肿瘤分化程度较差,瘤细胞异型性及多形性十分明星,核分裂象多见,瘤细胞胞质内可见弥漫多量均匀分布的细颗粒,呈毛玻璃样;肿瘤间质内可见密集多量淋巴细胞、浆细胞及嗜酸性粒细胞浸润。免疫组化染色:瘤细胞p16(3/4)、AE1(3/3)、AE3(3/3)、CK5(2/2)和CK8(2/2)(+)。结论宫颈GCC多见于年轻女性,临床表现以阴道不规则出血为主,肿瘤呈菜花样。组织学上,肿瘤分化程度较低,癌细胞异型性明显,胞质呈玻璃样需与鳞状细胞癌、腺鳞癌鉴别。     

肾嗜酸细胞腺瘤的临床病理学观察

目的观察肾嗜酸细胞腺瘤病理学特点并与其它具有嗜酸性细胞浆的肾上皮性肿瘤鉴别。方法观察４例肾嗜酸细胞腺瘤，在光镜观察基础上，运用免疫组织化学检测Ｃｙｔｏｋｅｒａｔｉｎ及Ｖｉｍｅｎｔｉｎ，并行Ｈａｌｅ胶体铁染色及电镜检查，与形态上类似的肾肿瘤进行鉴别。结果肾嗜酸细胞腺瘤的特点为：胞浆强嗜酸性，粗颗粒，腺泡状或实性片状排列，无坏死，无核分裂像或核分裂像罕见；Ｃｙｔｏｋｅｒａｔｉｎ８阳性，Ｖｉｍｅｎｔｉｎ阴性，Ｈａｌｅ胶体铁染色阴性，电镜下有多量粗大线粒体。据此，可与颗粒型肾细胞癌、混合型肾细胞癌及肾嫌色细胞癌鉴别。结论肾嗜酸细胞腺瘤是有病理特点的良性肾肿瘤，根据组织学改变，免疫组化、组化染色及电镜特点可与胞浆嗜酸性的肾癌鉴别，具有临床意义。     

肾上腺原发性肝样腺癌临床病理观察

目的 探讨肾上腺原发性肝样腺癌的病理诊断和临床病理特点.方法 对1例肾上腺肝样腺癌进行光镜、电镜观察和免疫组化标记,并复习相关文献.结果 肾上腺肿瘤镜下可见腺癌和肝细胞癌样区域,两者交错分布,肝细胞癌样区域瘤细胞呈腺管状和梁索状排列,肿瘤间质较少,瘤细胞间可见血窦样结构.瘤细胞呈多边形,胞质丰富嗜酸,核异型性明显,核分裂象易见.电镜见胞质线粒体丰富、高尔基体发达,可见层状排列的粗面内质网;细胞间可见毛细胆管结构.免疫组化HepParl、AFP和pCEA(+),Inhibin-α(-).全身其他脏器检查未发现肿瘤,随访13个月无复发及其他脏器转移.结论 肾上腺发生的肝样腺癌具有肝细胞癌的病理学特征,依据光镜、电镜观察和免疫组化标记并除外转移,方可确诊.目前,连同本例仅见2例报道.提示在肾上腺肿瘤的诊断中要注意与这类肿瘤的鉴别.     

膀胱原发透明细胞癌1例报告及文献复习

目的 阐明膀胱透明细胞癌病理形态学特征和诊断依据。方法 运用光镜、电镜及免疫组化方法观察分析，结合文献资料进行研究探讨。结果 瘤细胞胞质透明，呈腺管状与实性巢状浸润生长。间质红染的团块状结构。瘤细胞PAS染色阳性，免疫组化CK、EMA及CA125阳性，vimentin、CEA、CgA阴性。电镜见胞质中大量糖原颗粒聚集，并见特征性的天才密电子小体。结论 膀胱原发透明细胞癌是一种少见的膀胱低分化癌，可以来源于苗勒管上皮。     

乳腺淋巴上皮瘤样癌3例临床病理分析

目的探讨乳腺淋巴上皮瘤样癌的临床及病理形态学特点、诊断及鉴别诊断。方法应用光镜观察、免疫组化染色等方法对3例乳腺淋巴上皮瘤样癌进行分析,并复习文献。结果肿瘤组织呈结节状或弥散分布,主要由密集的成熟淋巴细胞组成,有时有纤维条索分隔;癌细胞单个或排列呈小簇状、巢状、条索状,散布于淋巴细胞中。癌细胞体积大,胞质丰富、淡染或略呈嗜酸性,圆形泡状核,核仁明显。免疫组化示癌细胞CK（＋）,CD30（-）;病毒检测EBV与HPV均（-）。结论乳腺淋巴上皮瘤样癌是一种罕见而形态独特的乳腺癌亚型,形态与发生于其他器官的淋巴上皮瘤样癌类似,常与淋巴瘤、髓样癌等混淆;免疫组化有助于鉴别。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.