肾血管平滑肌脂肪瘤10例临床病理观察

目的探讨肾血管平滑肌脂肪瘤（RAML）的临床病理特征。方法结合文献分析讨论10例RAML的临床病理资料及免疫组化染色结果。结果 10例RAML年龄30~53岁,平均42岁,男女之比为2.3：1。均为混合型,弥漫表达Melan-A、SMA,HMB45呈散在阳性。结论①肾血管平滑肌脂肪瘤为良性肿瘤,构成该肿瘤的基本成分是平滑肌、血管和脂肪;②由于肾血管平滑肌脂肪瘤常出现平滑肌细胞不同程度的异型性,致使该肿瘤组织结构复杂多变,导致诊断困难;③平滑肌是本病唯一可靠的诊断性成分,并特征性地表达MelanA、SMA、HMB45,是确立诊断的主要依据。     

肾上皮样血管平滑肌脂肪瘤2例的临床病理及免疫组化特征

目的:探讨肾上皮样血管平滑肌脂肪瘤(EAML)的临床病理诊断要点及鉴别诊断.方法:对2例肾EAML患者的临床资料、大体标本检查、组织病理及随访结果进行分析,用免疫组化染色观察了黑色素瘤相关抗原[HMB45、(Pan) melanoma marker Ah21]、角蛋白(CK)、平滑肌肌动蛋白(actin)、上皮膜抗原(EMA)、波形蛋白(Vim)、S-100等在EAML中的表达.结果:EAML主要由弥漫、形态多样的上皮样肿瘤细胞组成,胞质丰富、核大异型,核仁明显,典型AML的血管和脂肪成分不明显或缺乏.肿瘤细胞特征性的免疫表型是HMB45和actin的特异性标记阳性,而上皮细胞标记(CK、EMA)阴性.结论:EAML是血管平滑肌脂肪瘤的罕见亚型,通过对大体标本的仔细观察及广泛取材,仍可发现少量的异常厚壁血管及脂肪组织,时诊断有帮助;免疫组化对诊断及鉴别诊断有重要意义.     

肺淋巴管平滑肌瘤病伴右肾血管平滑肌脂肪瘤临床病理观察

目的探讨肺淋巴管平滑肌瘤病(PLAM)伴右肾血管平滑肌脂肪瘤(AML)的临床特点、影像特征、病理学和预后,对比两种疾病的异同点。方法回顾性分析1例PLAM伴AML患者的临床、影像和病理资料,并复习文献。结果 PLAM主要发生于育龄期女性,临床症状无特异性,以咳嗽、胸闷、气短和呼吸困难为主;病理检查示肺组织内不同成熟度的平滑肌细胞在细支气管壁、肺泡壁、淋巴管壁和血管壁周围增生,肺实质呈囊性变。免疫组化染色示增生的平滑肌细胞SMA、HMB45、desmin和PR均(+),ER(-);瘤样淋巴管D2-40(+)。肾AML由比例不等的脂肪组织、梭形平滑肌细胞和异常的厚壁血管3种成分构成,梭形或上皮样的平滑肌细胞SMA、HMB45和desmin(+)。结论 PLAM伴肾AML少见,病因不清,同属于具有血管周上皮样细胞分化的肿瘤。PLAM和肾AML同时出现,应考虑是否与结节性硬化症有关。     

肺淋巴管平滑肌瘤病的临床病理特征及影像学表现

目的肺淋巴管平滑肌瘤病（PLAM）的临床病理及影像学特征。方法观察2例肺淋巴管平滑肌瘤患者的临床特点、影像学表现、病理特征。结果患者肺组织特征性改变为两肺弥漫均匀分布的薄壁囊性气腔;肺活检病理示：沿肺淋巴管、小气道、小血管的管壁及其周围的平滑肌细胞弥漫性异常增生,免疫组织化学染色结果显示HMB45、SMA均阳性,ER、PR均阴性。结论PLAM临床罕见,是肺慢性进行性恶化的肿瘤性疾病,本病的确诊需要肺组织病理学检查。     

血管周上皮样细胞肿瘤的临床病理学观察

目的探讨肾脏和肝脏血管平滑肌脂肪瘤(AML)、肺脏透明细胞"糖"瘤(CCST)、子宫血管周上皮样细胞肿瘤(PEComa)的共同病理学特征及共同的诊断和鉴别诊断要点。方法对肾脏和肝脏AML、肺脏CCST、子宫PEComa各1例的标本进行病理形态学和免疫组织化学观察。结果 4例不同部位和3种命名的肿瘤有相同的形态学,主要表现瘤细胞以上皮样细胞的组成,呈薄壁血管周围排列,免疫组化4例均HMB45阳性(4/4),3例SMA阳性(3/4)。结论上述发生在不同部位、不同命名的肿瘤,在形态和免疫组化上有共同特点:即血管周排列、瘤细胞呈上皮样;免疫组化表达黑色素标记物,亦可表达平滑肌标记物,这些特点支持统一为血管周上皮样细胞肿瘤(PEComas)的看法。     

肝血管平滑肌脂肪瘤3例临床病理分析

目的对肝血管平滑肌脂肪瘤的临床病理特点、免疫组化、诊断及鉴别诊断进行探讨.方法3例肝AML标本均经常规处理,HE染色和S-P法免疫组化染色,光镜观察.结果肿瘤位于肝左叶2例,肝右叶1例.3例肿瘤内均可见平滑肌、脂肪、畸形血管及造血细胞,其中上皮样平滑肌细胞为肿瘤的主要成分(＞90%),瘤细胞排列呈弥漫片状、条索状或小梁状.1例肿瘤中可见炎性假瘤样区域.免疫组化染色上皮样平滑肌细胞表达HMB45强阳性.术后随访3～31个月,未见肿瘤复发.结论肝AML的形态学特点有别于肾AML,肿瘤中3种成分的比例、瘤细胞形态及组织结构均有很大变化,必须与多种肿瘤相鉴别.平滑肌细胞表达HMB45强阳性,是诊断肝AML的可靠依据.     

肝血管平滑肌脂肪瘤7例临床病理观察

目的 探讨肝血管平滑肌脂肪瘤的病理形态、免疫组化及诊断和鉴别诊断要点。方法 对7例肝血管平滑肌脂肪瘤病例进行临床病理与免疫组织化学观察。结果 7例肝血管平滑肌脂肪瘤男:女＝3：4，平均43岁，肿瘤大小4．6－23cm，平均10cm 。4例混合型，2例梭形细胞型，1例上皮样型。7例均HMB－45（＋），3例desmin( )，5例actin( )。结论 肝血管平滑肌脂肪瘤的3种成分分布、比例及病理形态变化多样，并易见髓外造血，HMB－45阳性细胞是诊断肝血管平滑肌脂肪瘤的重要指标之一。     

肾错构瘤25例临床病理特征

目的 探讨肾错构瘤的临床病理特点、诊断和治疗方法。 方法 回顾性分析25例肾错构瘤 (AML)患者的诊治情况 ,其中15例进行免疫组化观察。结果 15例HMB -45均阳性。结论 AML的3种成分分布、比例及病理形态变化多样 ,HMB -45阳性细胞是诊断AML的重要指标之一 ,对肿瘤直径>4cm的患者可作肾部分切除术及原位冷冻肿瘤剜除术     

淋巴结血管肌瘤性错构瘤5例临床病理分析

目的 探讨淋巴结血管肌瘤性错构瘤(AHL)的临床病理学特征、发病机制、诊断及鉴别诊断。方法 回顾性分析联勤保障部队第九○○医院病理科5例AHL临床资料,总结其病理学特征、免疫表型及预后,并复习相关文献,探讨其可能的发病机制。结果 5例AHL中男性3例、女性2例,年龄21～77岁,中位年龄55岁。眼观：病灶处切面灰白色,质韧。镜检：淋巴结实质被不规则增生的厚壁血管、平滑肌及纤维组织所取代,病变从门部向实质内延伸,增生的平滑肌细胞围绕在血管壁周围或不规则穿插在纤维组织中。免疫表型：平滑肌组织表达Desmin、SMA,病理诊断：AHL。结论 AHL临床少见,部分病理医师对此病认识不足,提高对本病的认识可避免漏诊与误诊。     

血管平滑肌脂肪瘤10例临床病理分析

目的探讨血管平滑肌脂肪瘤(AML)、上皮样血管平滑肌脂肪瘤(EAML)的临床病理学及良、恶性的诊断和鉴别诊断。方法对10例AML及其亚型EAML进行临床病理学及免疫组化观察,随访和复习相关文献。结果经典型AML4例,肌瘤型1例,EAML5例。其中4例发生在肾、肝和子宫。镜检:瘤细胞上皮样、疏松、不规则结节状或片状或围绕血管生长,核圆、稍大,轻度异型性,核分裂象1个/50HPF;发生于阔韧带的1例EAML,瘤细胞上皮样,核大、深染、核异型,可见核内包涵体,核分裂象1个/10HPF,胞质明显嗜酸,肿瘤性坏死和肿瘤组织侵及同侧卵巢及盆腔壁;随访近5年,疑似局部复发和肝转移。其他病例均未见复发转移。免疫组化:HMB45、melanA和SMA(+),desmin部分(+),S-100蛋白、CD34、CK、EMA和CgA(-)。结论 AML大部分为良性病变,但瘤组织出现坏死、瘤细胞核的活性增加、核的不典型性和肾外扩散时应高度考虑为恶变。对EAML病例即使是良性形态也必须密切随访,同时应与相似形态的肿瘤鉴别。     

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.     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.