弹簧式自动活检针经皮肺穿刺活检的应用价值

38例肺部肿块患者在X线或CF导向下采用弹簧式自动活俭外经度肺穿刺活检，其中肺癌26例，肺穿刺活栓准确率92．3％；良性病变12例，肺穿刺活栓准确率917％.术后少量气胸2例（53％），痰中带血2例（5.3％），尤其后者具有安全、准确、成功率高等特点，对外周肺肿块的诊断起着重要作用。     

2005年举办国家级继续教育的通知

针吸细胞学检查临床应用已久，但对临床上不能触及较小的病灶针吸细胞学检查成功率往往极低。本文对645例乳腺微小肿物进行B超定位针吸细胞学检查，以确定该方法在诊断中的作用及价值。     

THE SELECTIVE USE OF FINE CATHETER PERITONEAL CYTOLOGY AND LAPAROSCOPY REDUCES THE UNNECESSARY APPENDICECTOMY RATE

The effect of a management protocol incorporating the selective use of fine catheter peritoneal cytology (FCPC) and laparoscopy on the unnecessary appendicectomy rate was studied in adult patients (≥16 years) treated at one district general hospital over an 11 -month period. Appendicectomy was performed on 62 adult patients managed according to this protocol, six (10%) of whom had a histologically normal appendix and no other acute condition requiring surgery. A further 57 patients underwent appendicectomy after standard clinical assessment and investigation without the use of FCPC or laparoscopy. Nineteen (33%) of these patients had a histologically normal appendix removed, with no other acute condition requiring surgical treatment. The selective use of FCPC and laparoscopy significantly reduced the unnecessary appendicectomy rate from 33% to 10% (χ² = 10.0, P<0.005). The more widespread use of these techniques in patients with suspected appendicitis is therefore recommended.     

ALLERGIC INFLAMMATION : III. THE FINE STRUCTURE OF COLLAGEN FIBRILS AT SITES OF ANTIGEN-ANTIBODY INTERACTION IN ARTHUS-TYPE LESIONS

The fine structure of collagen fibrils at sites of antigen-antibody interaction is described. Following injection of antigen (BSA or ferritin) into the center of the cornea of hyperimmune rabbits, an acidophilic ring of precipitate forms at the periphery of the cornea, where antigen and antibody interact in optimal proportions. The precipitate is soon removed by infiltrating polymorphs, but persists longer in leukopenic animals. Electron microscopic examination of the cornea showed no alteration of the collagen fibrils in the area of antigen-antibody precipitation or in the remaining cornea. Contrary to many claims there was no swelling, fragmentation, or disintegration of the fibrils and they had a normal periodicity. Polymorphs infiltrated the precipitates and phagocytosed the antigen-antibody complexes. There was some ultrastructural evidence that degradation of the complexes took place in the polymorphs.     

ADENOMYOEPITHELIOMA OF THE BREAST

Adenomyoepithelioma is a rare disorder characterised by simultaneous proliferation of ductal epithelium and myoepithelial cells. It is more common in salivary glands or skin, and only rarely found in breast tissue. Adenomyoepithelioma of the breast was first described in 1970 by Hamperl.¹ Since then, approximately 55 cases have been described in the literature; the largest review, by Tavassoli in 1991, reported 27 of these cases.² Because of the small number of cases reported, the natural history of adenomyoepithelioma of the breast remains uncertain. We report a further case which was treated by local excision, and follow-up for two years has revealed no evidence of local recurrence or metastatic spread.     

MANAGEMENT OF EARLY BREAST CANCER

SUMMARY There is a popular misconception that, despite extensive research, there has been no improvement in either quality or quantity of life for patients with early breast cancer. This may have arisen because of inadequate communication of the results of both clinical trials and laboratory experiments which have greatly excited those who are working in the field.     

GLOMERULAR LESIONS OF SUBACUTE BACTERIAL ENDOCARDITIS

1. In most cases of chronic or subacute bacterial endocarditis due to the endocarditis coccus (Streptococcus viridans), there exists a distinctive pathological lesion in some of the glomeruli due to bacterial emboli. 2. The salient features of the pathological picture are first, the involvement of one or more loops of a variable number of glomeruli; secondly, the absence of any visible disease in the uninvolved glomeruli and in the uninvolved portions of affected glomeruli; and thirdly, the association in most of the bacterial cases of all the various stages of the glomerular process often seen in a single microscopical section. 3. The lesion does not occur in cases of acute endocarditis, and up to the present time it has been absent in cases of subacute bacterial endocarditis due to organisms other than the endocarditis coccus. 4. In a group of cases having vegetations that are typical of those in the active stage of subacute endocarditis (except that they are free from bacteria and healing or healed), the healed stage of this distinctive glomerular lesion is present, although it is less extensive than in the active bacterial cases. 5. These cases, therefore, are most probably examples of subacute bacterial endocarditis due originally to the endocarditis coccus, but in which the endocardial vegetations have become free from bacteria rather early in their course and are now healing or healed, as claimed by Harbitz and Libman. 6. During the active bacterial stage of the disease, if the glomerular lesions are not too numerous, the only symptoms produced will be an almost constant hematuria, usually demonstrable only microscopically. If the glomerular lesions are very numerous, symptoms resembling those of subacute hemorrhagic nephritis may occur and may even cause a fatal issue. If the glomerular lesions are very numerous but not sufficient to cause death, and the cardiac lesion should go on to healing, a contracted kidney, secondary to the glomerular lesion, may subsequently ensue and produce the typical symptoms and death. In such a case, the finding of the healed or healing lesion of subacute bacterial endocarditis will be accidental.     

THE HISTOLOGICAL LESIONS OF EXPERIMENTAL GLANDERS

The bacillus of glanders may be so modified in virulence as to produce experimentally lesions differing widely in their histological features. The highly virulent culture causes primary necrosis and disintegration of the tissue followed by the invasion of the injured area by polymorphonuclear leucocytes. The bacilli of moderate virulence give rise to a primary lesion of an acute inflammatory nature in which the cells show no evidence of necrosis or disintegration. The attenuated bacilli produce primary tissue proliferation with the formation of epithelioid and giant cells. There is every grade of lesion between the acute exudative and the chronic proliferative depending upon the toxicity of the cultures. The glanders lesion whether exudative or proliferative is focal in character. The strong toxins of the glanders bacilli cause degeneration or necrosis of cells and exudation, while the dilute and weak toxins produce proliferation. The giant cell of glanders undoubtedly originates from the endothelial cell of the blood and lymph channels and is formed by division of the nucleus of the endothelial cell and not by cell fusion. Histologically the lesion of glanders resulting from the culture of a low degree of virulence is proliferative and is analogous to tuberculosis; the lesions are focal and bear an intimate relation to the glanders bacillus.     

BRAIN LESIONS OF THE DOMESTIC RABBIT

Lesions of meningoencephalitis were found in 55 per cent of 372 rabbits comprising the laboratory stock regarded as healthy, others with snuffles or dying from different affections while being kept under observation, and still others which were employed for experimental purposes, such as tumor transplantation and Treponema pallidum inoculation. None was injected intracerebrally. The lesions consist in the main of infiltration with mononuclear cells occurring around the blood vessels, in the meninges, in the cortex, and under the ependyma of the lateral ventricles, together with particular focal necrotic areas in the cortex. The incidence of these histopathological changes varies in different series of animals; in those supposedly normal and in rabbits inoculated with a transplantable tumor or with Treponema pallidum material, the percentage of positives was from 40 to 60; in those suffering from miscellaneous diseases, such as pneumonia, septicemia, etc., the percentage was 70, and in rabbits ill with snuffles, as many as 76 per cent were affected. Marked lesions were observed in 47.5 per cent of the total. The histopathological picture observed in these rabbits corresponds to those offered by a number of investigators as evidence of the transmission of certain nervous diseases of man to this animal. The accidental cerebral lesions in the rabbit, of a wide variety, and of frequent occurrence, are to be regarded as existing before any experimental procedure is begun. Their recognition is of the utmost importance in the interpretation of experimental results based on the presence of similar changes in this animal.     

经支气管针吸活检对支气管狭窄病因诊断的研究

纤维支气管镜(以下简称纤支镜)检查时经常遇到支气管狭窄,我们从1999年11月15日～2000年6月12日经纤支镜开展了57例针吸活检(TBNA)对支气管狭窄病因诊断的研究,现报告如下.     

A HISTOLOGICAL STUDY OF THE SKIN LESIONS OF PELLAGRA

The cutaneous lesions in pellagra consist of an early erythema, or, in occasional cases, of vesicles or bullous formations which are followed by hyperkeratosis and pigmentation, resulting in a dry, dark brown scaliness. These various lesions are similar to those normally produced by the action of sunlight, but are much more marked. The histological phenomena of the erythematous and bullous stage are those of a mild acute inflammatory reaction, together with a degeneration in the superficial layers of the corium. Following this degeneration, which involves not only the general connective tissue but the connective tissue of the blood vessels, there is a reparative change evidenced histologically by an increased cellularity of the corium and the presence of fibroblasts. The capillaries also are increased in number and much dilated. Apparently as a result of this increased vascularity of the corium, there is an increased proliferation of the epithelium resulting in a thickening of the epidermis. This increase in thickness of the epithelial layer is especially marked in the prickle cells and the stratum granulosum. In the later stages, in an effort to secure a firm basement membrane, the epithelium is seen to dip down deeply into the rarefied connective tissue. About the blood vessels during the reactionary process are found collections of lymphoid cells, a few plasma cells, but no mast cells or eosinophiles. That the irritant producing the degeneration in the corium is sunlight in the presence of some predisposing factor, is suggested by the enormous increase in pigment formation in the epithelial cells and by the large number of chromatophores in the superficial layers of the corium. This pigmentation is autochthonous in both types of cell. There is no reason for believing that the pigment is formed in the cells of the corium and thence discharged into the epithelium, or that the reverse process takes place. The predisposing factor inducing the changes in the corium is, apparently, a lessened resistance of the epithelium to the violet and ultra-violet rays, due to some metabolic insufficiency on the part of the epithelial cells. Further observation may justify the conclusion that throughout the body, pellagra is a disease essentially of the epithelium, including the nervous system, this pathological condition manifesting itself by an insufficient or altered function.     

内镜下局部切除十二指肠乳头病变治疗的研究

目的：探讨内镜下局部切除十二指肠乳头病变方法的安全性及疗效。方法：内镜下采用圈套器对7例确诊为十二指肠乳病变患者取病变乳头进行电凝切除，部分患者切除后为防止胰管或胆管狭窄放置内支架，切除后标本送病理检查，定期随访。结果：7例病变全部完整切除。病理结果为腺瘤2例，局部高度不典型增生3例，乳头癌2例。治疗后黄疸短期内明显降低，胰腺炎无复发。无明显并发症发生。结论：内镜下十二指肠乳头切除术，对于十二指肠乳头腺瘤、局部不典型增生、早期肿瘤等疗效肯定，并可以避免外科手术。     

神经内镜下显微外科治疗颅内病变

目的：探讨神经内镜在显微外科治疗颅内病变中的作用。方法：应用神经内镜结合CRW立体定向仪在MRI或CT导向下进行颅内肿瘤活检和囊肿开窗疏通术，或在神经内镜辅助下行小切口开颅手术切除颅内肿瘤和行三又神经根减压术。结果：30例病人，包括4例颅内肿瘤，4例透明隔囊肿，7例蛛网膜囊肿，2例鞍区胆质瘤，5例三又神经痛，8例桥小脑角肿瘤，术后所有病人均恢复良好，无严重并发症出现。结论：神经内镜有助于颅内病变的诊断和治疗，尤其是与立体定向术结合具有微创、准确、简便、并发症少、恢复快等优点，是微侵袭神经外科最重要的治疗手段之一。     

扇形开口注射器针头灭菌盒的研制

扇形开口注射器针头灭菌盒呈扁圆柱形，盒盖开有可闭合扇形开口，盒底有可闭合通气孔。用其盛装注射器针头，经１２１℃压力蒸汽作用２０ｍｉｎ可达灭菌。灭菌后，每天打开扇形开口取盒内针头一次，第６天取出的针头开始有菌生长     

STK15在乳癌组织中的表达

目的探讨乳癌组织中癌基因STK15的表达情况。方法应用免疫组化SP法检测41例乳癌及30例乳腺纤维瘤组织中STK15蛋白的表达。结果 STK15蛋白在乳癌和乳腺纤维瘤组织中的阳性表达率分别为68.3%（28/41）、36.7%（11/30）,二者之间差异有显著性（χ^2=6.999,P〈0.05）。STK15蛋白表达与乳癌的TNM分期及组织学分级有关（χ^2=8.794、8.261,P〈0.05）,且STK15蛋白阳性表达强度与乳癌病人的TNM分期有关（χ^2=5.895,P〈0.05）。结论乳癌组织中存在STK15基因高表达,STK15基因可能是导致乳癌发生的因素之一。     

经支气管针吸活检对肺癌的诊断价值

该文对５５例颖为支气管肺癌的肺部病变行纤维支气管镜检查。无可视肿瘤表现者采用经支气管针吸活检术（简称ＴＢＮＡ）检查,并与刷检及术后病理组织细胞学结果进行比较,结果证明５５例病人中ＴＢＮＡ与刷检的正确诊断率分别为９２．７％（５１／５５）和５０．９％（２８／５５）;其中肺癌４１例ＴＢＮＡ和刷检正确诊断率分别为９０．２％（３７／４１）和３４．１％（１４／４１）;ＴＢＮＡ检查明显优于刷检（Ｐ〈０．０１）。     

82例肝占位性病变的超声诊断分析

本文回顾分析了82例术前作过B超检查的肝占位性病变,并与手术和病理结果相对照,结果为肝肿瘤性病变占92.68%(76/82),其它占位性病变占7.32%(6/82).76例肿瘤中,恶性占92.11%(70/76),良性占7.89%(6/76).超声定性误诊4例,漏诊1例,定位假阴性3例,诊断符合率90.24%(74/82).     

EFFECTS OF OBSCURE LESIONS ON ORGAN WEIGHTS OF APPARENTLY NORMAL RABBITS

A group of 350 normal rabbits was studied with reference to the occurrence of obscure lesions of various kinds and the probable or possible effect of such lesions or disease processes on organ weights. The results of the investigation are presented in the form of comparative tabulations. It was found that so long as the animals remained in apparently good health the values obtained for organ weights of animals with lesions did not differ materially from those for animals that were entirely free from lesions. There were, however, slight deviations from the normal which appeared to be significant in that they suggested a functional response similar in character to the more marked changes in mass and mass relationships that occur in rabbits presenting clinical symptoms of disease due to the same causes.     

早期乳腺导管内癌钼靶X线表现及免疫组化分析

目的探讨乳腺导管内癌（DCIS）及导管内癌伴微浸润（DCIS-MI）的钼靶X线表现、免疫组化表达情况,分析二者之间的相关性。方法回顾性分析20例乳腺DCIS及36例乳腺DCIS-MI病人的钼靶X线表现,分析雌激素受体（ER）、孕激素受体（PR）、C-erbB-2及p53基因的表达情况,并分析影像学表现与上述标志物之间的相关性。结果钼靶X线表现为钙化33例,其中单纯钙化21例,钙化合并包块5例、结构紊乱5例、结节1例、腺体增厚1例;恶性钙化27例,中间钙化4例,良性钙化2例。表现为单纯包块2例、结节4例、结构紊乱9例、皮肤增厚2例。表现为阴性者6例。ER、PR、C-erbB-2、P53的阳性表达率分别为52.9%、52.9%、45.1%、58.8%。以非钙化组为对照组,恶性钙化与ER、PR、P53的表达无关（P〉0.05）,而与C-erbB-2表达有显著的相关性（χ2=4.850,P〈0.05）。结论乳腺DCIS及DCIS-MI的钼靶X线主要表现为钙化,恶性钙化与C-erbB-2的表达相关。