胃癌患者骨髓转移癌细胞的检测和临床观察

作者自１９９２年１１月至１９９４年６月应用膜上皮抗原（ｅｐｉｔｈｅｌｉａｌｍｅｍｂｒａｎｅａｎｔｉｇｅｎ，ＥＭＡ）单克隆抗体为探针，连续对８８例胃癌患者进行了１１３次骨髓中转移癌细胞的检测。８８例中查出阳性癌细胞者５８例，阳性率为６５．９％。癌细胞阳性率与胃癌分化程度有关，以低分化腺癌和粘液腺癌阳性率较高，分别为６０．９％和９３．９％。胃癌ＴＮＭ分期Ⅰ、Ⅱ、Ⅲ和Ⅳ期阳性率分别为４２．９％、５７．１％、７３．７％和６９．０％。骨髓转移癌细胞与淋巴结转移无明显关系。单纯手术、手术＋化疗以及手术＋化疗＋免疫治疗三组癌细胞转阴率分别为２５．０％、４２．８％和６２．５％。     

用聚合酶链反应技术诊断慢性淋病性尿道炎前列腺炎

用聚合酶链反应（ＰＣＲ）及前列腺液涂片镜检技术检测７９例男性慢性尿道炎及前裂为患者的淋球菌，结果ＰＣＲ阳性２２例，ＰＣＲ及涂片镜检均阳性１２例（５４．５％），ＰＣＲ阳性而涂片镜检阴性１０例（４５．５％），无一例涂片阳性而ＰＣＲ阴性者，涂片阳性率明显低于ＰＣＲ阳性率（Ｐ＜０．００５）。本文就ＰＣＲ检测男性慢性淋病性尿道炎及前列腺炎的价值进行初步讨论。     

用聚合酶链反应技术诊断慢性淋病性尿道炎及前列腺炎

用聚合酶链反应（ＰＣＲ）及前列腺液涂片镜检技术检测７９例男性慢性尿道炎及前列腺炎患者的淋球菌，结果ＰＣＲ阳性２２例，ＰＣＲ及涂片镜检均阳性１２例（５４．５％），ＰＣＲ阳性而涂片镜检阴性１０例（４５．５％），无一例涂片阳性而ＰＣＲ阴性者，涂片阳性率明显低于ＰＣＲ阳性率（Ｐ＜０．００５）。本文就ＰＣＲ检测男性慢性淋病性尿道炎及前列腺炎的价值进行初步讨论。     

环丙沙星治疗无合并症淋病疗效观察

环丙沙星治疗无合并症淋病疗效观察龙岩市第一医院泌尿科（龙岩３６４０００）陈建德苏芬我院泌尿科自１９９５年２月～１９９６年２月，收治尿道分泌物涂片检查确诊为淋病患者６０例，分别用环丙沙星和青霉素进行对照治疗。现报告如下。临床资料１．一般资料：本组６０例...     

急性淋病性腹膜炎32例诊治体会

急性淋病性腹膜炎３２例诊治体会阮俊钢１９９０年３月～１９９６年３月本院外科共收治急性淋病性腹膜炎３２例，作者对其临床表现治疗方法以及如何降低误诊率等问题加以分析探讨。一、临床资料１．３２例均为女性。年龄１５～４２岁。职业以个体职业者占大多数（２４例，...     

胃肠道间质瘤临床诊治分析(附48例报告)

目的探讨胃肠道间质瘤（GIST）的诊断与治疗。方法对我院1999年1月至2004年12月收治的48例GIST患者的病理特点及外科治疗进行回顾性分析。结果本组GIST发生部位：胃29例（60．4％），小肠11例（22．9％），结肠3例（6．3％），直肠4例（8．3％），肛管1例（2．1％）。主要临床表现为消化道出血（52．1％）和腹部肿块（35．4％），免疫组化表型CD117阳性率为83．3％（40／48），CD34阳性率为77．1％（37／48），SMA阳性率为27．1％（13／48），S-100阳性率为22．9％（11／48）。48例均行手术切除。全组术后均未行放、化疗，随访12-60个月，平均35个月，随访率为100％。良性及交界性患者均无复发；13例恶性者中6例复发，其中5例死亡。结论GIST在中老年人中好发，部位以胃及小肠最多见，以消化道出血、腹部肿块表现为主。肿瘤的大小是GIST良、恶性的重要临床指标。GIST的诊断有赖于病理形态学检查与免疫组化的结合。完整的局部手术切除是最有效的治疗手段。     

乳腺神经内分泌癌临床与病理分析（附7例分析）

目的探讨乳腺神经内分泌癌的临床及病理特征。方法白2005年4月至2008年6月收治女性乳腺神经内分泌癌7例。7例患者均进行综合治疗，并利用免疫组化法检测肿瘤细胞CgA、Syn、NSE、ER、PR、CerbB2、Ki67、p53的表达情况。结果7例均获随访．随访时间为7～45个月，平均22个月，均存活，无复发及远处转移。7例患者CgA和CerbB-2阳性率为71．4％（5／7）；Syn、NSE、PR、Ki67阳性率为100％；ER阳性率85．7％（6／7）；P53阳性率为14．3％（1／7）。结论乳腺神经内分泌癌是一类少见的特殊类型乳腺癌，神经内分泌标记物有助于该病的诊断及预后；综合治疗有利于提高该病患者的生存率，延长无病生存时间。     

保安地区淋病148例临床分析

我们于１９９３年１月至１９９８年５月,共收治农民淋病１４８例,现将１４８例临床资料分析报告如下：　　一、临床资料１４８例淋病患者均属尿道分泌物涂片检查发现细胞内有典型革兰氏阴性肾形双球菌。患者年龄在１５～５３岁之间,平均２２．５岁。男１１０例,女３８例。病期８～１５０天,平均２３．４天。已婚１３２例,未婚１６例。出外打工归来１２５例,在家配偶２３例。　　二、临床表现男性病例除了尿道口红肿、尿脓、尿痛以及尿频外,合并附睾炎者４５例（４０．９％）,前列腺炎３８例（３４．５％）,合并淋菌性结合膜炎３例…     

胆道手术抗生素的预防应用

１９８６年１月～１９９２年１２月，对２２４例慢性结石性胆囊炎患者行胆囊切除．其中７８例胆囊内胆汁普通培养，１６．７％出现细菌，而２４１例急性胆管炎的胆汁细菌培养阳性率高达７４．３％．胆汁中细菌对抗生素的敏感度依次为头孢菌素族、氨基甙类和半合成青霉素．本研究资料表明，为了预防胆道手术后并发感染，短期和超短期的用药方式是合理的．     

十二指肠乳头肿瘤的外科治疗

１９９０年１月至１９９８年３月收治十二指肠乳头肿瘤６８例，Ｂ超和ＣＴ检查诊断阳性率（基本准确）分别为６５．５％，８０．９％，ＥＲＣＰ检查４３例，全部确诊。５８例施行手术治疗，病理检查４３例均为腺癌，周围组织浸润和远处转移与肿瘤的大小无明显关系。主要手术方式：胰十二指肠切除４２例（其中保留幽门９例），切除率７２．４％，乳头肿瘤切除及乳头括约肌成形术１例，姑息性手术１５例。术后主要并发症有应激性溃疡７     

荧光探针定量聚合酶链反应检测684例女童泌尿生殖道淋球菌、沙眼衣原体、解脲支原体感染情况

目的了解女童泌尿生殖道淋病双球菌、沙眼衣原体、解脲支原体感染情况。方法对684例有泌尿生殖道感染症状的女童取阴道分泌物,采用荧光探针定量聚合酶链反应（PCR-荧光探针法）进行淋病双球菌、沙眼衣原体、解脲支原体检测。结果684例患儿19例淋病双球菌阳性,12例沙眼衣原体阳性,31例解脲支原体阳性。结论对于有反复泌尿生殖道感染的女童,临床上应考虑相关病原体感染的可能,建议进行此3种病原体的检查,以指导临床治疗。     

Usefulness of oral wash specimens for detecting Chlamydia trachomatis from high-risk groups in Japan

Orogenital sex is recognized as a route for the transmission of Chlamydia trachomatis (CT) which thus causes male chlamydial urethritis. Patients with a pharyngeal CT infection have no gross lesions, but CT was tested by pharyngeal swabs. In this study, the usefulness of oral wash specimens for detecting CT was compared to that of swab specimens. In addition, oral wash specimens were also used to screen for CT pharyngeal infection. Eighteen female commercial sex workers in whom CT was detected from pharyngeal swabs were re-examined using both methods. The positive rate for CT was 44% by swabs and 61% by oral wash specimens. Forty-eight male students with CT-positive urine were also screened for pharyngeal CT infection. The positive rates were 6% by swabs and 10% by oral wash specimens. Our findings therefore indicate that oral wash specimens more effectively detected pharyngeal CT infection than pharyngeal swabs.     

男性不育患者解脲支原体及沙眼衣原体感染与抗精子抗体关系的研究

目的:探讨在男性不育症中解脲支原体(UU)、沙眼衣原体(CT)感染与抗精子抗体(AsAb)的关系.方法:应用荧光定量PCR技术检测105例不育男性精液中UU和CT,应用ELISA法测定血清中的AsAb.结果:不育男性血清AsAb阳性率 34.3%(36/105),UU阳性率 32.4%(34/105),CT阳性率 25.7%(27/105).AsAb阳性组中UU阳性率 47.2%(17/36),阴性组中UU阳性率 24.6%(17/69),两组差异有统计学意义(P＜ 0.05).AsAb阳性组中CT阳性率 27.8%(10/36),阴性组中CT阳性率 24.6%(17/69),两组差异无统计学意义(P＞ 0.05).结论:UU和CT感染是不育症患者的常见病因,而UU是AsAb产生的重要原因之一.     

Accuracy of FDG-PET–CT in the Diagnostic Work-up of Vascular Prosthetic Graft Infection

ObjectivesTo investigate the diagnostic accuracy of fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) compared with computed tomography (CT) scanning and added value of fused FDG-PET–CT in diagnosing vascular prosthetic graft infection.DesignProspective cohort study with retrospective analysis.MaterialsTwenty five patients with clinically suspected vascular prosthetic infection underwent CT and FDG-PET scanning.MethodsTwo nuclear medicine physicians assessed the FDG-PET scans; all CT scans were assessed by two radiologists. Fused FDG-PET/CT were judged by the radiologist and the nuclear medicine physician. The concordance between CT and FDG-PET and the inter-observer agreement between the different readers were investigated.ResultsFifteen patients had a proven infection by culture. Single FDG-PET had the best results (sensitivity 93%, specificity 70%, positive predictive value 82% and negative predictive value 88%). For CT, these values were 56%, 57%, 60% and 58%, respectively. Fused CT and FDG-PET imaging also showed high sensitivity and specificity rates and high positive and negative values. Inter-observer agreement for FDG-PET analysis was excellent (kappa = 1.00) and moderate for CT and fused FDG-PET–CT analysis (0.63 and 0.66, respectively).ConclusionFDG-PET scanning showed a better diagnostic accuracy than CT for the detection of vascular prosthetic infection. This study suggests that FDG-PET provides a useful tool in the work-up for diagnosis of vascular prosthetic graft infection.     

低剂量电子计算机断层扫描对疑似急性下呼吸道感染老年患者的临床诊断价值及安全性

目的研究低剂量电子计算机断层扫描（CT）对疑似急性下呼吸道感染老年患者的临床诊断价值及其安全性。 方法收集2016年9月至2018年8月广州中医药大学深圳医院（福田）收治的92例疑似急性下呼吸道感染老年患者为研究对象，按随机数字表法分为观察组和对照组，每组各46例。其中对照组患者采用常规剂量CT扫描；观察组患者采用低剂量CT扫描。比较两组患者的诊断效能及辐射剂量，分析低剂量CT对急性下呼吸道感染者的诊断价值。 结果对照组和观察组患者CT检查对急性下呼吸道感染的阳性检出率分别为86.96%和82.61%，差异无统计学意义（χ² = 0.733、P = 0.392）。两组患者CT检查对急性下呼吸道感染诊断的灵敏度、特异度、阳性预测值以及阴性预测值差异均无统计学意义（P均> 0.05）。观察组患者平均辐射剂量为（1.28 ± 0.26）mSv，显著低于对照组[（3.12 ± 0.36）mSv]，差异有统计学意义（t = 28.102、P < 0.001）。 结论低剂量CT对疑似急性下呼吸道感染老年患者诊断价值与常规剂量CT检查相似，且辐射剂量小、安全性高。     

The clinical evaluation of 414 cases of male urethritis

PURPOSE: We reviewed the clinical data of male urethritis diagnosed as sexually transmitted disease with the aim of revealing its clinical features. PATIENTS AND METHODS: In a total number of 414 males diagnosed as having acute urethritis transmitted by sexual activities between January and December in 2000, clinical data were collected and analyzed. In addition, questionnaire concerning the awareness of pharyngeal infection was obtained. RESULTS: Their ages ranged from 16 to 60 years with a mean of 31 years. The source of infection was a commercial sexual worker (CSW) in 288 (69.6%) out of 414 cases. In 241 cases in whom an infection route was determined, 199 cases (82.6%) were considered to have an infection through oral sex. Microbiological examinations isolated Neisseria gonorrhea alone in 206 (49.8%), Chlamydia tracomatis alone in 47 (11.3%) and both in 46 (11.1%) cases. In our study, 57.5% and 20.8% of Neisseria gonorrhea strains were resistant to penicillin and new quinolones, respectively. Based on questionnaire, 174 (57.8%) out of 301 cases were not aware of possible infection from the pharynx through oral sex. CONCLUSION: The remarkable prevalence of gonococcal urethritis might be in part due to the lacking of awareness of infection through oral sex and sexual activities without a condom. Instruction on the prevention as well as the actual situation of urethritis is needed for general population with a broad age spectrum. The appropriate use of antimicrobial agents with sufficient susceptibility and less inductivity of drug-resistance is also of clinical importance.     

沙眼衣原体、解脲支原体感染与不孕的关系探讨

目的与方法：通过对宫颈粘液标本沙眼衣原体（CT）、解脲支原体（UU）及血清抗精子抗体（AsAb）的检测，探讨生殖道感染与不孕的关系。结果：CT、UU、AsAb在不孕组的检出率分别为29．41％、35．29％和38．23％；性病组分别为50．51％、67．01％和11．34％；对照组分别为5．75％、9．20％和1．15％。不孕组与对照组比较差异均高度显著（P＜0．001）。不孕组中CT或UU同时伴AsAb阳性者达69．23％。结论：作者认为CT和UU的生殖道感染是引起不孕的重要因素之一，建议作为不孕检测中的常规项目。     

Added value of SPECT/CT in patients suspected of having bone infection: preliminary results

AIM: We evaluated the contribution of SPECT/CT as an adjunct to combined three-phase bone scintigraphy (planar and SPECT) for diagnosing and localizing bone infection. Subsequently, the diagnostic performance of SPECT/CT was compared to visual fusion of SPECT with data of additional CT, X-ray, or MRI studies (SPECT + CT/X-ray/MRI). MATERIALS AND METHODS: Thirty-one patients suspected of bone infection, presenting pathological findings on triple-phase bone scintigraphy, underwent additional SPECT/CT. The SPECT/CT-technology combines the acquisition of SPECT and CT data with the same imaging device enabling perfect overlay of anatomical and functional images. (99m)Tc-DPD was used as radiopharmaceutical in all patients. For data analysis findings of bone scintigraphy (planar scans as well as SPECT) were categorized as positive, negative, or equivocal for the presence of osteomyelitis. In a second step, they were compared with SPECT/CT and SPECT + CT/X-ray/MRI with respect to localization and classification of lesions. Validation was achieved by surgery, biopsy, or by clinical follow up over at least 9 months including microbiological and radiological findings. RESULTS: Three-phase bone scan (incl. SPECT) correctly classified 7 lesions as positive and 11 lesions as negative for osteomyelitis. Six scans were interpreted false positive, two false negative, and five as equivocal. Rating the latter as positive for osteomyelitis, sensitivity of bone scan was (78%), specificity (50%). SPECT/CT was true positive in 7 patients, and true negative in 19. There were two false positive and two false negative findings, one scan was equivocal (sensitivity 78%, specificity 86%). Definition of anatomical localization of inflammatory foci was much easier by SPECT/CT due to better depiction of underlying anatomical details. SPECT + CT/X-ray/MRI yielded the highest sensitivity (100% compared to 78% of SPECT/CT), if equivocal findings (5/31 compared to 1/31 for SPECT/CT) are rated as true positive for osteomyelitis. Among radiological techniques, MRI (2 x FP) and CT (2 x FN) proved equal and expectedly superior to X-ray in delivering the correct diagnosis. CONCLUSION: SPECT/CT improves the diagnostic performance of three-phase bone scan for osteomyelitis by avoiding false positive or equivocal results. An additional benefit over visual fusion of SPECT with X-ray, CT, or MRI studies could not be confirmed in our study.     

Gonorrhea: update.

Gonorrhea is a worldwide sexually transmitted disease (STD) caused by Neisseria gonorrhoeae. Gonorrhea is the second most often reported STD in the United States behind chlamydia. An estimated 600,000 people each year in the United States are infected. Only about half this number of cases are reported. From 1975 through 1997, the national gonorrhea rate declined 74.3%. After a small increase in 1998, the gonorrhea rate has decreased each year since 1999. In 2003 the South had the highest gonorrhea rate among the four regions of the country. Antimicrobial resistance remains an important consideration in the treatment of gonorrhea. In 2003 the Gonococcal Isolate Surveillance Project found about 16% of collected isolates were resistant to penicillin and/or tetracycline. Since 1998 the number of ciprofloxacin-resistant isolates has been increasing with 270 (4.1%) being reported in 2003. Oral gonorrhea is rare, nonspecific, and varied and may range from slight erythema to severe ulceration with a pseudomembranous coating. The patient with gonorrhea poses little threat of disease transmission to the dentist. However, patients who have or have had gonorrhea should be approached with a measure of caution because they are in a high-risk group for additional STDs. The CDC has published recommendations for standard precautions to be followed in controlling infection in dentistry that have become the standard for preventing cross-infection. Strict adherence to these recommendations will, for all practical purposes, eliminate the danger of disease transmission between dentist and patient. Dentists should be aware of local statutory requirements regarding reporting STDs to state health officials. Syphilis, gonorrhea, and AIDS are reportable diseases in every state. Local health departments or state STD programs are sources of information regarding this matter.     

Added value of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of post-operative instrumented spine infection

PurposePost-operative instrumented spine infection (PISI) is an infrequent complication. Diagnosis of spinal implant infection can be difficult, especially in case of chronic infection.MethodsThis retrospective study attempts to evaluate the diagnostic performance of [¹⁸F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in PISI. Imagings were performed between April 2010 and June 2018 among patients referred for suspected chronic spinal implant infection. PET/CT were performed more than 12 weeks after surgery. PET/CT images were re-interpreted independently by two nuclear medicine physicians without knowledge of the patient's conditions. PET/CT data were analyzed both visually and semi-quantitatively (SUV_max). MRI results were collected from medical records. The final diagnosis of infection was based on bacteriological cultures or a twelve-month follow-up.ResultsForty-nine PET/CT were performed in 44 patients (22 women, median age 65.0 years). Twenty-two patients had a diagnosis of infection during follow-up. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for PET/CT were 86.4%, 81.5%, 79.2%, and 88.0%. Sensitivity, specificity, PPV and NPV were 66.7%, 75.0%, 66.0%, 75.0% respectively for MRI and 50.0%, 92.6%, 84.6% and 69.4% for serum C-reactive protein (CRP). Although these values were higher for PET/CT than for MRI or CRP, the differences were not statistically significant. In this setting, false positives with PET/CT can be observed in case of previous spine infection or adjacent segments disc disease. False negatives can result of extensive instrumented arthrodesis or infection with low virulence bacteria.ConclusionPET/CT is useful for the diagnosis of PISI. These results should be evaluated in further prospective study.