黏液样肾上腺皮质癌临床病理观察

目的阐述黏液样肾上腺皮质肿瘤的病理形态学特点及其鉴别诊断。方法对1例黏液样肾上腺皮质癌的组织病理学、组织化学及免疫组化结果进行观察分析,结合文献进行探讨。结果肿瘤呈胶冻样外观。瘤细胞呈腺样、条索状及包巢状漂浮在黏液中。ABPAS染色证实为细胞外黏液。免疫组化示Mart_1、αInhibin、CD56、vimentin( )。结论黏液样肾上腺皮质肿瘤是罕见的肾上腺皮质肿瘤。组织化学和免疫组化结果有助于鉴别诊断。     

黏液性肾上腺皮质腺瘤的临床病理分析

目的探讨黏液性肾上腺皮质腺瘤的临床病理特征。方法对1例黏液性肾上腺皮质腺瘤进行临床病理学及免疫组化分析,并进行文献复习。结果患者女,年龄40岁,上腹部、右腰部疼痛不适,增强CT示右侧肾上腺区软组织肿块。肿瘤有一层薄的纤维性包膜,突出的特征为间质内见较多的黏液,黏液内漂浮增生的多边形细胞呈条索状、假腺样、小巢样排列,多边形瘤细胞胞浆中等量,嗜酸性或嗜双色性,核圆,偶见小核仁,间质内纤维增生分隔瘤组织呈小结节状;其间夹杂有经典的肾上腺皮质腺瘤。免疫组化显示:黏液区内瘤细胞及经典的肾上腺皮质腺瘤瘤细胞阳性表达Ckpan、Syn、Inhibin-α、MelanA,不表达CK7、CK20、Villin、SMA、P63、Calponin、S100、CgA。结论黏液性肾上腺皮质腺瘤是一种少见的肿瘤,有独特的形态学表现,间质内黏液及黏液区内瘤细胞的特殊形态学表现,以及免疫组化是正确诊断和鉴别诊断的关键。     

肺母细胞瘤胸膜复发1例并文献复习

目的　探讨肺母细胞瘤的临床病理学特征及诊断与鉴别诊断要点。方法　对 1例肺母细胞瘤胸膜复发进行临床病理分析及免疫组织化学研究。结果　肺母细胞瘤临床表现胸痛、胸闷、憋气。镜下瘤组织由腺管样的上皮成份和肉瘤样间质结缔组织成分混杂而成。免疫组化 :瘤组织中的腺管成份CK (+ ) ,EMA(+ )。而幼稚间叶成份CK (-) ,EMA(-) ,Vimentin(+ ) ,S 10 0蛋白间叶成份弱 (+ ) ;上皮及间叶成分NSE ,CgA均 (-)。 结论　肺母细胞瘤是很少见的肿瘤 ,其诊断与鉴别诊断主要依靠病理组织学和免疫组织化学。     

胃丛状血管黏液样肌纤维母细胞瘤2例临床病理观察

目的探讨胃丛状血管黏液样肌纤维母细胞肿瘤(PAMT)的临床病理学特征及诊断、鉴别诊断要点。方法对2例胃丛状血管黏液样肌纤维母细胞肿瘤进行临床病理、免疫组化和电镜研究。结果临床表现为无症状或上腹部不适、疼痛。胃镜示肿物向胃腔内突出。镜下肿瘤在胃壁之间呈结节状、丛状生长,与胃壁平滑肌交错排列,肿瘤富于小的薄壁血管,细胞间富含黏液样或纤维黏液样基质;瘤细胞核呈梭形或卵圆形,核仁不明显,胞质轻度嗜酸性,细胞异型性不明显。免疫组化示肿瘤细胞SMA、MSA和h-caldesmon(+),个别细胞PR(+),CD117、CD34和S-100(-)。电镜示肿瘤有肌纤维母细胞分化。结论胃丛状血管黏液样肌纤维母细胞肿瘤是罕见的肿瘤,具有独特的形态特征,其诊断和鉴别诊断主要依靠病理组织学和免疫组化。     

乳腺原发性黏液性囊腺癌临床病理观察

目的探讨乳腺原发性黏液性囊腺癌(MCA)的临床病理特征、免疫组化及鉴别诊断。方法对1例乳腺原发性MCA进行病理形态学及免疫组化分析,并复习相关文献。结果乳腺原发性MCA肉眼观肿块与周围组织分界较清,切面囊实性,囊内为黏液样物质。镜下可见大小不等的囊腔,囊壁内衬柱状上皮,细胞质内富含黏液,细胞核位于基底部。部分囊壁肿瘤细胞形成细胞簇或有纤维血管轴心的乳头状结构。部分肿瘤细胞质内黏液减少,出现不同程度的异型性,向鳞状上皮分化。免疫组化:肿瘤细胞E-cadherin和CK7(+),PR和c-erb B-2(2+),Ki-67阳性指数为55%、CK20、ER和GATA3(-)。结论乳腺原发性MCA是一种罕见肿瘤,需要与来自卵巢、胰腺或肠道的转移性肿瘤、乳腺柱状细胞黏液癌、乳腺黏液囊肿样病变等鉴别。确诊需结合组织学形态、免疫组化及临床病理资料综合分析。     

胃丛状纤维黏液瘤:一种新近认识的胃间叶性肿瘤CSCD

目的探讨胃丛状纤维黏液瘤(PF)的临床病理特征、诊断与鉴别诊断。方法对1例胃丛状纤维黏液瘤的临床资料、病理形态学及免疫组化进行观察,并结合文献探讨其诊断与鉴别诊断。结果胃丛状纤维黏液瘤在临床上无特异性,患者多因上腹部不适或腹部包块就诊。组织形态学上,胃丛状纤维黏液瘤呈特征性的丛状、结节状在肌层中生长,肿瘤细胞常短梭形或卵圆形,胞质稍嗜酸,染色质细腻,核仁不明显,无明显异型,核分裂象罕见,肿瘤细胞散在分布于富含薄壁血管的黏液样或纤维黏液样基质中。免疫组化:肿瘤细胞SMA、caldesmon和calponin(+),CD34、ALK、S-100、desmin、CD117和Dog-1均(-)。结论胃丛状纤维黏液瘤是发生于胃的一种极为罕见的间叶源性肿瘤,因其具有独特的丛状生长方式,故结合其临床病理学特征和免疫组化结果可对其作出正确诊断。     

胃丛状纤维黏液瘤:一种新近认识的胃间叶性肿瘤

目的探讨胃丛状纤维黏液瘤(PF)的临床病理特征、诊断与鉴别诊断。方法对1例胃丛状纤维黏液瘤的临床资料、病理形态学及免疫组化进行观察,并结合文献探讨其诊断与鉴别诊断。结果胃丛状纤维黏液瘤在临床上无特异性,患者多因上腹部不适或腹部包块就诊。组织形态学上,胃丛状纤维黏液瘤呈特征性的丛状、结节状在肌层中生长,肿瘤细胞常短梭形或卵圆形,胞质稍嗜酸,染色质细腻,核仁不明显,无明显异型,核分裂象罕见,肿瘤细胞散在分布于富含薄壁血管的黏液样或纤维黏液样基质中。免疫组化:肿瘤细胞SMA、caldesmon和calponin(+),CD34、ALK、S-100、desmin、CD117和Dog-1均(-)。结论胃丛状纤维黏液瘤是发生于胃的一种极为罕见的间叶源性肿瘤,因其具有独特的丛状生长方式,故结合其临床病理学特征和免疫组化结果可对其作出正确诊断。     

子宫腺瘤样瘤15例临床病理分析

目的 探讨子宫腺瘤样瘤的发生、临床病理特点、免疫组化表达特征及鉴别诊断。方法 对15例子宫腺瘤样瘤进行临床病理、组织化学及免疫组织化学观察。结果 15例子宫腺瘤样瘤占同期子宫切除标本的1．81％，肿瘤多位于子宫浆膜下及近浆膜的子宫肌壁间，内膜下少见；2例呈弥漫性生长，13例呈结节状，结节直径0．5～5cm不等，临床表现无特征性。镜下见肿瘤由大小不等、形态不一的腺样及腔隙样结构组成，伴有间质平滑肌增生，分为丛状型、腺管型、脉管型及囊肿型。8例腔隙内黏液样物阿尔辛蓝染色（＋），PAS染色（-）。免疫表型：AE1／AE3、vimentin和calretinin（＋），CEA、ER、PR和CD31（-）。结论 子宫腺瘤样瘤并非罕见，支持间皮起源，临床及病理检查均易误诊和漏诊。免疫组化检查可作为诊断及鉴别诊断的重要参考依据。其生物学行为为良性，预后良好。     

女性生殖系统腺瘤样瘤18例临床病理分析

目的:探讨女性生殖系统腺瘤样瘤的组织发生、临床病理特点、诊断与鉴别诊断。方法:回顾分析18例腺瘤样瘤的临床病理资料并复习文献。结果:18例腺瘤样瘤占同期女性生殖系统手术标本的0.85%,其中子宫12例、输卵管5例、卵巢1例。子宫腺瘤样瘤多位于浆膜下或近浆膜的肌壁间,7例伴发子宫肌瘤或腺肌症。输卵管及卵巢腺瘤样瘤位于浆膜下向表面突出。肿瘤直径0.5～4.5cm。临床表现无特异,病理上肿瘤由大小不等、形态不一的腺样、腔隙样结构组成,伴有间质平滑肌、纤维组织增生。腺腔内黏液样物AB阳性,PAS阴性;免疫组化:CK(AE1/AE3)、Vimentin、Calretinin、HBME1阳性,CD34、CEA、ER、PR阴性。随访无复发或恶变。结论:腺瘤样瘤是来源于间皮的良性肿瘤,临床及病理均易误诊或漏诊,对标本的全面取材及免疫组织化学的正确使用有助于提高本病的检出率。     

腺泡状横纹肌肉瘤临床病理学分析

目的探讨腺泡状横纹肌肉瘤(ARMS)临床病理学特征、免疫组化、FISH及鉴别诊断。方法收集9例腺泡状横纹肌肉瘤患者的临床病理学资料,通过光镜形态学观察、免疫组织化学及FISH检测,并复习相关文献。结果 9例患者中,男性5例,女性4例,发病年龄2~58岁(平均年龄31岁,中位年龄34岁)。肿瘤最大径3~10 cm。镜下:肿瘤细胞被纤维间质间隔成腺泡状或形成实性巢片状细胞团结构,并可见血管走行于纤维间隔中。因肿瘤细胞缺乏粘附力,常悬浮于腺泡腔内,形成特征性的腺泡状结构。肿瘤细胞体积小而数量丰富,呈小圆形细胞样。免疫组织化学显示MyoD1、Myogenin及Desmin均强(+),8例CD56(+)。检测3例FOXO1A基因发生分离。结论腺泡状横纹肌肉瘤发病率较低,发病年龄比较年轻,Myogenin及MyoD1具有良好的特异性及敏感性,较为容易与其他类型的小圆细胞恶性肿瘤作出鉴别,但与胚胎性横纹肌肉瘤存在相同的表达,可根据形态学及FISH检测FOXO1A基因相关易位明确诊断。     

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.