卵巢囊性颗粒细胞瘤临床病理观察

目的 探讨卵巢囊性颗粒细胞瘤的临床病理学特征、诊断及鉴别诊断.方法 复习l例卵巢囊性颗粒细胞瘤的临床资料、大体及镜下组织病理学表现,行免疫组化染色,并复习相关文献.结果 患者女性,30岁.右侧单房性卵巢囊肿,18.5 cm×l6.5 emx2cm大小,囊壁厚薄不均;镜下囊内壁由多层颗粒细胞构成,部分囊壁可见散布实性成片的颗粒细胞;瘤细胞胞质稀少,核圆形、卵圆形,部分细胞有核沟.免疫组化:颗粒细胞α-inhibin、CD99和vimentin呈(+).结论 卵巢囊性颗粒细胞瘤较少见,正确诊断依靠组织形态学,特征为发现单纯一致的颗粒细胞、可见核沟及找到Call-exner小体或微滤泡结构;免疫组化染色有助于明确诊断.     

疑似硬化性间质瘤的幼年型颗粒细胞瘤一例报道并文献复习

目的:探讨卵巢幼年型颗粒细胞瘤的临床病理特点。方法:对我院1例疑似硬化性间质瘤的幼年型颗粒细胞瘤行病例报道、病理观察并复习相关文献。结果:患者,女,19岁,下腹痛2月余,B超及MRI检查、肿瘤标志物均提示右侧卵巢良性肿瘤。大体所见,卵巢肿物1个,大小4 cm×3 cm×2 cm,切面囊实性,色黄,镜下肿瘤大部分呈实片状、结节状排列,瘤细胞多角形,胞质淡红染,核圆形、卵圆形,深染,偶见核沟,见少数核分裂像,部分区域瘤细胞黄素化较明显,肿瘤组织有滤泡形成,免疫组化病理结果显示免疫表型inhibin-α、CD99、Vimentin、S-100、SMA均呈阳性。术后随访患者12个月,月经恢复正常,无肿瘤复发。结论:卵巢幼年型颗粒细胞瘤是一种罕见的肿瘤,临床工作中应重视其病理特点。     

卵巢幼年型颗粒细胞瘤临床病理观察

目的：探讨幼年型颗粒细胞瘤的临床病理学特点及诊断要点。方法：对2例幼年型颗粒细胞瘤进行临床资料、病理形态学及免疫组织化学观察,并结合文献对其诊断及鉴别诊断进行探讨。结果： 2例镜下可见肿瘤细胞卵圆形或短梭形,胞质淡染,部分空泡状,成巢分布,呈多结节样生长,与周围卵巢组织有明显分界,局部区域有黏液样变性,血管丰富,部分细胞生长活跃,核分裂易见（5~7个/HPF）,核沟不明显,未见Call-Exner小体。免疫组织化学染色结果：ER、PR、Vimentin和α-inhibit阳性,Ki-67增殖指数25%~40%不等。结论：卵巢幼年型颗粒细胞瘤是一种少见肿瘤,易与其他肿瘤混淆导致误诊,其临床病理特点应引起临床医师重视。     

卵巢幼年型颗粒细胞瘤一例及文献复习

目的 探讨卵巢幼年型颗粒细胞瘤的临床病理特点.方法 对我院1例卵巢幼年型颗粒细胞瘤进行临床病理观察,行Vimentin、CD99、α-inhibin、p53、S-100蛋白、EMA、CD117、AFP、HCG、PLAP、HMB45、SMA、CK及Ki-67免疫表型监测和随访,并复习相关文献.结果 患者女,9岁,出现阴道流血20 d,雌二醇升高.超声提示右侧附件肿瘤.大体所见,卵巢肿物1个,大小10 cm x8 cm×7 cm,切面囊实性,有出血,镜下肿瘤大部分呈实片状排列,小部分可见滤泡样结构.肿瘤细胞呈圆形,部分胞质透明,黄素化,富含脂质,核呈轻到中度异型,罕见核沟,核分裂易见.Vimentin、CD99、p53、S-100蛋白及SMA呈阳性表达、α-inhibin散在阳性,CK、EMA、CD117、CD30、AFP、HCG、PLAP及HMB45均阴性.Ki-67增殖指数80%.随访6个月,无复发.结论 卵巢幼年型颗粒细胞瘤是一种罕见恶性肿瘤,其临床病理特点应引起l临床医师重视.     

卵巢Sertoli-Leydig细胞瘤的影像表现(附3例报道及文献复习)

目的探讨卵巢Sertoli-Leydig细胞瘤的影像表现及临床特征,以提高对该肿瘤的认识及诊断水平。材料与方法搜集经病理证实的3例卵巢SertoliLeydig细胞瘤的CT、MRI影像资料,观察病变的影像学特征,并分析病变的影像学特征与预后的关系。结果 3例患者(17岁,71岁,58岁)共发现3个肿瘤,其中2例位于左侧卵巢,1例位于右侧卵巢,病变于CT、MRI均表现为边界清楚的实性或囊实性肿块,实性部分于T2WI呈等或稍高信号,囊性部分多位于实性部分内部,呈T2WI高信号,DWI病变呈高信号。增强扫描,病变实性部分呈明显强化。3例患者中有2例雄激素水平升高,临床呈男性化表现。结论卵巢Sertoli-Leydig细胞瘤有一定的影像学特征,若发现卵巢实性或以实性成分为主的囊实性肿瘤,且实性成分于T2WI呈等或稍高信号时,结合患者临床病史,应考虑到该肿瘤的诊断。     

颗粒细胞瘤43例临床病理分析

目的探讨颗粒细胞瘤(GCT)的临床病理特征,以提高对该肿瘤的认知和诊断水平。方法应用常规病理学技术、免疫组化Polink-2HRP染色系统对43例软组织颗粒细胞瘤进行石蜡切片、HE及免疫组化染色分析,其中15例结合术中快速冷冻切片形态。依据WHO(第4版)软组织肿瘤分类诊断标准对其病理特征进行综合分析。结果 43例GCT中38例光镜下肿瘤细胞为多边形,呈巢片状排列,细胞间为胶原纤维束,胞核小、圆或卵圆形,胞质内见嗜伊红颗粒;5例细胞呈梭形,丰富密集。肿瘤与周围组织无明显边界;免疫组化:S-100、CD56、Syn、NSE、vimentin及CD68(+),CK、GFAP、desmin及Melan A(-);术中快速冷冻切片会诊9例GCT、1例误诊为恶性、5例延迟;常规病理诊断:40例GCT、3例非典型GCT。结论 GCT是较少见的外周神经组织肿瘤,准确及时的病理诊断,是保证临床治疗效果的关键。     

卵巢无性细胞瘤临床病理分析并文献复习

目的:探讨卵巢无性细胞瘤的临床病理学特点及诊断要点。方法:对2例无性细胞瘤进行临床资料、病理形态学及免疫组化观察,并结合文献对其诊断及鉴别诊断进行探讨。结果:镜下肿瘤细胞被窄的纤维组织分隔呈巢状、岛屿状、条索状,纤维隔内有多少不等的淋巴细胞浸润,瘤细胞与核的大小外观呈明显一致性,胞质丰富淡染,核大圆形,核仁明显,核分裂像易见。免疫组化示肿瘤细胞PLAP呈不同程度阳性。结论:掌握无性细胞瘤的病理特点,提高对无性细胞瘤的认识,对避免误诊是至关重要的。     

肺硬化性肺细胞瘤23例临床病理分析

目的:探讨肺硬化性肺细胞瘤(pulmonary sclerosing pneumocytoma,PSP)患者的临床表现、影像学特点和病理学诊断。方法:收集23例PSP患者的临床病理资料,分析其临床表现、影像学特点、病理学特征以及免疫表型,并复习相关文献进行探讨。结果:PSP多见于成年女性,多数患者无症状(13/23,56.5%)。23例患者中,3例(3/23,13.0%)术前经影像学诊断为PSP,13例(13/23,56.5%)于术中经冷冻病理检查诊断为PSP,诊断准确率均较低。大体检查可见,肿块边界清晰,无包膜或有假包膜,切面灰白至灰褐色,7例有出血,出血区呈暗红色。光镜检查可见实性、乳头状、血管瘤样和间质硬化4种结构,表面立方形细胞及间质圆形或多角形细胞2种细胞。免疫表型为,TTF-1在表面细胞及间质细胞均强表达,AE1/AE3、CAM5.2、EMA表面细胞胞膜及细胞质强表达,间质细胞部分呈细胞质弱表达,仅在表面细胞表达Napsin A及SP-A,仅在间质细胞表达Vimentin。23例患者均获得随访,随访时间为4~50个月,其中1例术后9个月发现对侧肺叶有直径为1.5 cm的小结节,未行手术,仍在随访中,其余均无复发及转移。结论:PSP患者缺少特征性的临床和影像学表现;术中冷冻病理检查误诊率高,确诊需要进行石蜡组织形态学观察和免疫组织化学标记检测。     

易被误诊为肿瘤的良性病变:结节性组织细胞/间皮增生

目的 探讨结节性组织细胞/间皮增生的临床病理特点、诊断和鉴别诊断.方法 对1例发生于肺的结节性组织细胞/间皮增生进行组织病理学和免疫表型观察,结合临床资料进行分析并复习相关文献.结果 患者男性,43岁.因自发性气胸复发急诊入院.术中见右侧胸膜腔严重粘连,右上、中、下肺叶均见大小不等的肺大泡.组织学,局部上皮样细胞呈结节状分布,细胞为多边形或类圆形,多镶嵌式排列;核类圆形为主,核染色质较细腻,核仁不明显,见曲核及核沟;胞质空淡或淡红颗粒状,部分细胞有轻度异型,偶见核分裂象,见少许散在的嗜酸性粒细胞浸润.免疫表型:结节区细胞CD68广泛强( );结节状区的囊壁侧 calretinin、CK5/6、Ckpan、CK7和Erda( );呈连续带状分布,结节内见少许散在的阳性细胞,S-100蛋白偶见( );CD1a、CgA、Syn、HNB45和TTF1均(-);Ki-67呈少量散在( ).结论 结节性组织细胞/间皮增生是一种罕见的良性病变,形态学需与肺的透明细胞瘤(糖瘤)、神经内分泌癌、透明细胞癌、朗格汉斯细胞组织细胞增生症、异位脑膜瘤和间皮增生性病变相鉴别,免疫组化示CD68广泛强( ),并混杂少许散在的间皮细胞而明确诊断.     

卵巢类固醇细胞瘤8例临床病理分析

目的探讨卵巢类固醇细胞瘤的临床病理学特征。方法对8例卵巢非特异性类固醇细胞瘤进行HE及免疫组化染色并结合临床资料进行文献复习。结果肿瘤实性,界限清楚,肿瘤细胞呈巢、索状或弥漫性分布,细胞大,圆形或多角形,胞质丰富,泡沫状或嗜酸性颗粒状,部分肿瘤内含丰富毛细血管网和血窦。免疫组化,所有病例calretinin、CD99和vimentin(+),CK灶状(+),部分病例inhibin和melan-A(+)。诊断时需与妊娠黄体瘤、黄素化的颗粒细胞瘤和卵泡膜细胞瘤及透明细胞癌、血管性肿瘤、腺癌等鉴别。结论卵巢类固醇细胞瘤是一种罕见的卵巢肿瘤,结合临床资料、组织学形态及免疫组化有助于诊断。     

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.