Preoperative cutaneous lymphoscintigraphy in malignant melanoma

To identify the regional lymph node basins cutaneous lymphoscintigraphy with technetium 99m rhenium sulfide colloid (99mTc-ReS) was performed in 45 patients and with technetium 99m antimony sulfide colloid (99mTc-Sb2S3) in seven patients after excisional biopsy of the primary tumor. All patients had skin tumors located in the face or neck or on the trunk with 47 cases of cutaneous malignant melanoma and 5 cases of benign or premalignant lesions. In 48 patients the scintiscans 1 hour after perilesional injection of the tracer colloid clearly showed the lymphatic drainage patterns from the tumor sites, of them 25 patients demonstrated unidirectional drainage, whereas the remaining 23 patients had multidirectional drainage to two or three lymph node groups. There were technical difficulties in performing the examinations in four patients. The authors recommend cutaneous lymphoscintigraphy as a safe, simple and reliable technique for mapping the lymphatic drainage preoperatively in patients with Stage I cutaneous malignant melanoma of axial localization.     

Stage migration after minor changes in histologic estimation of tumor burden in sentinel lymph nodes

BACKGROUND:

Melanoma metastasis size estimates are of prognostic significance for groups of patients, but to the authors' knowledge, measurement consensus does not exist.

METHODS:

Maximum metastasis diameter, maximum centripetal tumor depth, microanatomic location of metastases, and complete metastasis volume were measured in 156 positive sentinel lymph nodes (SLNs) from 99 melanoma patients.

RESULTS:

The number of SLN‐positive patients was increased by up to 41% using complete step‐sectioning compared with less extensive protocols. Assessing maximum metastasis diameters, up to 27% of patients positive by the less extensive protocols went from 1 metastasis diameter group to a larger one when complete step‐sectioning was performed. No patients were down‐staged. Apparently minor protocol changes (eg, adding an extra step) led to substantial changes in maximum metastasis diameter. Similar protocol‐dependent results were noted measuring the maximum centripetal tumor depth and the microanatomical location of metastases. By using semiquantitative tumor burden estimates, stage migration was always unidirectional (ie, moving from a lower to higher stage). Stereologic tumor burden estimates in step‐sectioned SLNs also varied according to the number of step sections assessed, but could increase, decrease, or remain constant, so that stage migration was multidirectional.

CONCLUSIONS:

Adding extra steps to pathology protocols when assessing semiquantitative parameters leads to unidirectional stage migration (“the protocol trap”). This systematical bias makes it difficult to base treatment decisions on semiquantitative metastasis size estimates. Although based on metastatic melanoma, the principles described herein will apply when measuring nodal tumor burden in other metastasizing cancers, including breast carcinoma. Cancer 2009. © 2009 American Cancer Society.     

Quantitative Abbildungskonzepte mit multidirektionalen Ultraschall-Echodaten zur Abbildung der Rückenmuskulatur

A multidirectional ultrasonic imaging technique using new imaging modalities for the diagnosis of the back musculature after a discotomy is presented. The system estimates texture parameters (co-occurrence parameters) from multidirectional echo data and displays them in a spatially resolved manner. The data acquisition of the multidirectional echo data is performed by a sector scanner, which is mechanically moved in lateral direction over the human back. Thus, multiple radio frequency ultrasonic images of the same cross-sectional plane are acquired. The single images, recorded from different directions of insonification contain uncorrelated speckles. Consequently, texture parameters can accurately be estimated using very small segment sizes (1.2 mm × 1.2 mm). In vivo images of the human back after a surgery demonstrate the performance of the imaging system.     

单向式全胸腔镜肺叶切除术治疗老年肺癌的临床疗效观察

目的:探讨单向式全胸腔镜肺叶切除术对老年肺癌患者疗效及血清CRP、PCT与生存率的影响。方法:从我院2012年7月至2014年10月收治的老年肺癌患者中选取148例作为研究对象,随机将其划分成治疗组和对照组,每组各74例。对照组使用传统路径胸腔镜肺癌根治术,治疗组采用单向式全胸腔镜肺叶切除术治疗。对比两组患者手术疗效、手术前后血清C-反应蛋白（C-reactive protein,CRP）、降钙素原（procalcitonin ,PCT）水平变化,统计并发症、复发及生存情况。结果:治疗组手术时间、术中出血量、术后胸腔引流量、引流管放置时间、住院时间均明显低于对照组(P<0.05),两组术后3天视觉模拟评分（VAS）、淋巴结清扫数目比较差异不具有统计学意义(P>0.05);术后1、3、6个月,治疗组一秒用力呼气容积（FEV1）、用力肺活量（FVC）、FEV1/FVC均低于术前,但呈不断增高趋势,且治疗组FEV1、FVC明显高于对照组(P<0.05);治疗组总并发症发生率为13.51%,明显低于对照组24.32%(P>0.05);两组术后血清CRP、PCT水平均明显增高,治疗组增高幅度明显低于对照组（P<0.05）;两组术后肿瘤复发例数及术后1年生存率、术后3年生存率比较,差异不具有统计学意义(P>0.05)。结论:单向式全胸腔镜肺叶切除术对老年I、II期肺癌患者手术疗效较好,可明显改善各项手术指标,加快患者恢复,且并发症发生率、远期复发率及生存率与传统路径胸腔镜肺癌根治术并无较大差异。     

Multidirectional differentiation in a newly established human epithelioid sarcoma cell line (GRU-1) with co-expression of vimentin, cytokeratins and neurofilament proteins.

A new permanent cell line (GRU-1) derived from the lymph-node metastasis of a human epithelioid sarcoma was established in tissue culture. Immunohistochemically, the original tumor had exhibited an intriguing potential for multidirectional differentiation with features of mesenchymal, epithelial and neural differentiation, evidenced by the co-expression of vimentin, cytokeratins and neurofilament proteins, respectively. This capability for multidirectional differentiation was fully preserved in the cultured cells. GRU-1 tumor cells proved to be uniformly positive for vimentin and a considerable proportion of the tumor cells exhibited a positive reaction for cytokeratins and neurofilament proteins. The neural markers neuron-specific enolase (NSE) and synaptophysin were observed in a small proportion of GRU-1 cells. Ultrastructurally, GRU-1 cells showed desmoplastic activity in vitro, being enmeshed by collagen fibrils. DNA distribution, as studied by flow cytophotometry, revealed DNA-diploidy (DNA index = 1) and a G0/G1-proportion of 70.5%. After heterotransplantation in nude mice, GRU-1 tumor cells expressed vimentin and cytokeratin only, whereas the neural markers could not be further demonstrated.     

Computerised Arthrotomography of the Glenohumeral Joint

Computerised arthrotomography of the glenohumeral joint is an extension of double contrast arthrography. It is of particular value in the assessment of patients with shoulder in stability, including patients in whom the diagnosis of recurrent subluxation requires substantiation, and shoulders which may be the site of multidirectional instability. It also appears to be of value in assessment of the articular surfaces following severe trauma. It should also be helpful in the detection of bicipital lesions and loose bodies.     

卵巢癌肿瘤干细胞的研究进展

卵巢癌肿瘤干细胞是从卵巢癌组织及癌性腹腔积液中分离出的一小群具有自我更新和多向分化潜能的细胞,与卵巢癌的高复发率、强耐药性密切相关.因此治疗晚期卵巢癌的关键在于研究以肿瘤干细胞为靶向的治疗方法.随着对卵巢癌肿瘤干细胞的成功分离鉴定,为卵巢癌的基因靶向治疗提供了可能.     

甲状腺术后引流口粘连的多因素分析

目的探讨影响甲状腺术后引流口粘连的因素。方法对同一手术组甲状腺术后放置引流的173例患者6个因素进行回顾性分析。采用单因素（P≤0.05）进行非条件Logistic回归分析。结果 173例患者引流口粘连率28.3%（49/173）,其中轻度36.7%（18/49）,中度59.2%（29/49）,重度4.1%（2/49）。引流物、引流物放置部位等因素在不同组间粘连率差异有统计学意义（P〈0.05）。多因素分析提示引流口粘连与引流物显著关联。结论甲状腺术后引流口粘连与多种因素有关,而引流物是其中的重要因素。     

Small cell undifferentiated carcinoma of the minor salivary gland containing exocrine, neuroendocrine, and squamous cells

The light microscopic, electron microscopic and immunohistochemical features of a small cell undifferentiated carcinoma of the minor salivary gland are presented. The tumor was composed predominantly of undifferentiated small cells with focally admixed neuroendocrine, exocrine and squamous cells, occasionally arranged in an organoid manner. The presence of vasoactive intestinal polypeptide in the tumor was found immunohistochemically. In addition, the tumor cells stained with Grimelius' impregnation. Immunohistochemically the tumor contained cells that reacted positively with the antibodies to carcinoembryonic antigen, 66K keratin polypeptide, or human salivary amylase. These findings indicate that a small cell undifferentiated carcinoma of the minor salivary gland, reported here, exhibits focally multidirectional differentiation as well as neuroendocrine cell derivation.     

Short Versus Long-term Postoperative Drainage of the Axilla After Axillary Lymph Node Dissection. A Prospective Randomized Study

Background. Axillary lymph node dissection (ALND) is a standard procedure in the treatment of breast cancer. Current practice following ALND involves several days of drainage of the axilla to reduce the formation of seroma. The aim of this study is to investigate the feasibility of 24 h drainage. Study design. A prospective randomized trial was performed comparing 24 h drainage to long-term drainage. The primary outcome measure was duration of hospital stay. Formation of seroma and wound related complications were secondary outcome measures. Results. Fifty patients were randomised to the 24 h drainage group and 50 patients to the long-term drainage group. 24 h drainage was associated with a shorter hospital stay (2.5 versus 4.6 days, p < 0.001). Seroma aspiration was required in 76% of the patients after 24 h drainage and in 64% after long-term drainage (p = 0.19). The number of wound related complications was higher after long-term drainage (13 versus 9, p = 0.33). Infectious complications were seen in 11 patients after long-term drainage versus 6 after 24 h drainage (p = 0.18). Conclusion. These results indicate that 24 h drainage following ALND is feasible and facilitates early hospital discharge. Furthermore, 24 h drainage is not associated with excess wound related complications compared to long-term drainage.     

中心静脉导管胸腔闭式引流后局部灌注卡铂联合艾迪对癌性胸腔积液患者生存质量的影响

目的观察中心静脉导管胸腔闭式引流后卡铂胸腔灌注联合艾迪对癌性胸腔积液患者生存质量的影响。方法70例癌性胸腔积液患者随机分为闭式引流组(36例)和非闭式引流组(34例),对其生存质量进行比较。闭式引流组均用中心静脉导管置管行胸腔闭式引流,引流12~24 h待胸腔积液放尽后从胸腔引流管注入稀释卡铂500 mg,夹管24 h后继续引流24~36 h。同时静脉用艾迪50 ml,1次/d,15 d为一周期。非闭式引流组进行传统胸腔穿刺后局部灌注卡铂,方法同上。结果闭式引流组和非引流组比较,疼痛缓解率、Karnofsky评分、体重评分及生存质量评分有明显提高,差异均有显著性(P<0.01)。结论中心静脉导管胸腔闭式引流后局部灌注卡铂联合艾迪(AIDI)能明显改善症状、控制癌痛,增加患者体重,并提高患者生存质量。     

引流管口渗液收集袋的设计及应用

目的:探讨引流管口渗液收集袋对穿刺引流管口顽固性渗液的应用及效果。方法:对84例发生穿刺引流管口顽固性渗液的患者,随机分为两组,A组42例患者使用引流管口渗液收集袋,B组42例患者使用常规方法换药,观察两组患者引流管周围刺激性皮炎的发生、愈合,渗液的引流和收集效果,以及患者的舒适度和换药费用的比较。结果:应用引流管口渗液收集袋进行穿刺管口渗液的收集,利于保护穿刺口皮肤,观察引流液的性质,降低了换药成本。结论:引流管口渗液收集袋对引流口进行无菌处理,具有显著的优点,结合高质量的护理,对保护穿刺口皮肤,即减轻患者的痛苦及经济负担,又减轻了医务人员的工作量。     

中心静脉导管胸腔闭式引流术在肺癌胸腔积液中的应用及护理

目的探讨中心静脉导管胸腔闭式引流术在胸腔积液中的应用效果及护理方法。方法选择30例采用中心静脉导管胸腔闭式引流术治疗的肺癌胸腔积液患者作为观察组,另选择30例采用传统胸腔闭式引流术治疗的肺癌胸腔积液患者作为对照组,比较两组患者的引流效果、生活质量及护理满意度。结果观察组患者的总有效率高于对照组,胸腔积液消失的时间、引流时间、引流期间的并发症发生率低于对照组,每日引流量多于对照组,引流后疼痛率低于对照组,差异均有统计学意义(P<0.05)。观察组患者生活质量的改善率高于对照组,护理满意度高于对照组,差异均有统计学意义(P<0.05)。结论中心静脉导管胸腔闭式引流术的引流效果较好,良好的护理措施是保证引流成功的关键。     

Basic principles of flow cytometry

Although the basic principles of flow cytometry have changed little in the past quarter century, the applications of this technology have evolved substantially. As in the past, cytometers interrogate individual cells or particles in a stream with a laser as the cells move past a set of stationary detectors. Increasingly, more colors of fluorescence are being detected by cytometers, faster analysis and sorting rates are becoming possible, cytometers capable of multidirectional sorting are being marketed, and more reagents are becoming available for a wide variety of applications. Furthermore, flow cytometry has not stopped evolving. The development of narrow spectrum flourescent probes, the integration of molecular biologic techniques with flow cytometry, and the evaluation of cell-free markers such as cytokines will be key components in the continuing evolution of flow cytometry.     

恶性高位胆道梗阻经皮经肝胆道引流方式的疗效分析

目的：探讨恶性高位胆道梗阻患者经皮经肝胆道引流方式对术后近远期疗效影响,为临床选择适当的治疗方式提供依据。方法-回顾性分析我院108例恶性高位胆道梗阻患者,比较单侧引流（68例）和双侧引流（40例）,左右肝管是否相通,引流材料对近期胆红素下降值和生存情况的影响。结果：三组术后3—5天胆红素的下降值明显,但无统计学差异（P〉0．05）。随访1—36个月,单侧组和双侧组、单枚引流管与单枚支架生存率没有显著差异（P〉0．05）。结论：恶性高位胆道梗阻以右侧入路单侧引流为主,生存期预计大于3个月,放置胆道支架,否则置入胆道引流管。     

单孔胸腔镜下肺癌术后胸腔引流时间的影响因素分析北大核心

目的:探讨单孔胸腔镜下肺癌手术术后胸腔引流时间的影响因素。方法:本研究采用回顾性分析方法,回顾我院2018年01月至2019年12月原发性肺癌患者经单孔胸腔镜手术治疗的病例199例。按照术后胸腔引流时间分为两组,Ⅰ组(术后胸腔引流时间<5天)和Ⅱ组(术后胸腔引流时间≥5天)。对于影响术后胸腔引流时间的可能因素在两组间先采用单因素分析的方法筛选,再将筛选出来的对术后胸腔引流时间可能有意义的影响因素进行二项Logistic多因素回归分析。结果:经单因素分析及二项Logistic多因素回归分析结果显示:年龄≥60岁、手术部位、肺段切除术、胸膜粘连、手术时间≥180 min、术后早期下床活动是术后胸腔引流时间的独立影响因素(P<0.05)。结论:对于具有多个延长术后胸腔引流时间的独立影响因素的患者,应制定个体化管理方案,尽可能减少术后胸腔引流时间,减少住院天数,加快患者康复。     

术中使用Hem-o-lok血管夹对右侧肺癌术后引流的影响

目的:探讨术中使用Hem-o-lok血管夹对右侧肺癌患者术后引流的影响。方法:回顾性研究2015年1月至2018年11月期间，同一术者行右侧肺癌手术和纵隔淋巴结清扫术的患者153例，根据术中是否应用Hem-o-lok血管夹夹闭纵隔淋巴管残端，将本研究分为实验组和对照组。根据统计学检验方法评估两组患者留置引流管时间、平均引流量、术后24 h引流量以及各个层级引流量。结果:对比两组患者，应用Hem-o-lok血管夹夹闭纵隔淋巴管残端可以降低术后引流量≥300 mL/d、≥400 mL/d、≥500 mL/d的发生概率，缩短住院时间，减少术后24 h引流量、平均引流量。结论:术中应用Hem-o-lok血管夹对术后患者康复具有积极意义。     

Sylvian meningioma without dural attachment in an adult

Summary A 69 year-old man developed sudden-onset multidirectional, constant, involuntary ocular movements associated with vertigo, truncal ataxia and involuntary movements of the lower limbs. These features were typical of opsoclonus-myoclonus-ataxia syndrome (OMS). MRI of the brain was normal. CSF studies showed a single oligoclonal IgG band. A chest x-ray showed a 2-centimeter lesion in the periphery of the left lung. Fine needle aspiration biopsy of this lesion revealed large B-cell lymphoma. OMS can be either idiopathic or a paraneoplastic manifestation of underlying malignancy. 20 of OMS cases are paraneoplastic in origin; breast and lung cancer are responsible for 70 of these. Association of this syndrome with non-Hodgkins lymphoma is rare, with only one case previously reported.     

彩色多普勒超声成像引导下经皮经肝胆管穿刺置管引流术的应用价值

目的 探讨经彩色多普勒超声成像(CDFI)引导下经皮经肝胆管穿刺置管引流术(PTCD)的临床应用价值.方法 在CDFI引导下对224例恶性胆道梗阻性黄疸患者行PTCD术置管248根次,选择左肝外叶下段胆管(左路)118根次,右肝胆管(右路)130根次,其中左右肝胆管分别置管者16根次.结果 224例248根次置管总成功率为99.59%(247/248),一针成功率为92.33%(229/248),其中一针左路成功率[96.61%(114/118)]明显高于右路[88.46%(115/130)],差异有统计学意义(P＜0.05).结论 CDFI引导下PTCD安全、简便、微创、成功率高,是治疗阻塞性黄疸的有效方法.     

影响肺癌术后胸腔引流时间的多因素分析

目的:探讨肺癌患者术后胸腔引流时间的各种影响因素。方法:回顾总结302例原发性肺癌手术诊治病人的临床资料。按术后胸腔引流时间分为两组,分别为Ⅰ组（引流时间≤5天）和Ⅱ组（引流时间＞5天）。对可能影响术后引流时间的因素在两组间采用单因素分析和二项Logistic多因素回归分析。结果:术后胸腔引流时间≤5天的154例（51.0%）,＞5天的148例（49.0%）。Logistic回归分析结果显示:年龄、开胸手术、术后使用白眉、单肺通气、淋巴清扫数、胸膜粘连及手术时间是术后引流时间的独立影响因素。结论:对于具有多个独立影响因素的患者,应加强围手术期个体化管理,制定合理的治疗策略,以减少术后胸腔引流时间。