胃神经鞘瘤超声内镜下被误诊为胃间质瘤4例并文献复习*

目的为了提高超声内镜(EUS)对胃神经鞘瘤的检出率。方法回顾分析2008年5月-2015年6月温州医科大学附属第一、第二医院和台州市第一人民医院4例病理及免疫组化确诊为胃神经鞘瘤但经EUS误诊为胃间质瘤的临床资料及EUS的影像特征并文献复习。结果 4例胃神经鞘瘤均为女性且均为良性,胃镜下4例病灶均为单发,有3例位于胃体,1例位于胃底;EUS下病灶均起源于胃固有肌层,病灶处呈低回声团块,回声均匀,边界清楚,内部回声均未见钙化灶或囊性变;2例病灶周围可见光晕现象。文献复习发现:胃神经鞘瘤好发于女性;周围光晕现象可能为胃神经鞘瘤的特征性表现;钙化、囊性液化改变在胃神经鞘瘤中较少见,在胃间质瘤中较常见。结论位于固有肌层的胃神经鞘瘤与胃间质瘤在EUS下很难区分;对病灶位于胃体、超声图像示病灶起源于固有肌层,呈低回声、回声均匀、边界清楚的女性患者,需仔细观察病灶内部回声是否有钙化、囊性变以及病灶周围是否有光晕现象,综合考虑,除需考虑胃间质瘤外还要排除胃神经鞘瘤的可能性。     

Efficacy,Safety, and Tolerability of Telcagepant in the Treatment of Acute Migraine: A meta‐Analysis

Although triptans are widely used for treating acute migraine, they are contraindicated or not effective in a large proportion of patients. Hence, alternative treatments are needed. Calcitonin gene–related peptide receptor antagonists, such as telcagepant, have been under investigation as a treatment for acute migraine. A meta‐analysis of the efficacy of telcagepant vs. placebo and triptans (zolmitriptan or rizatriptan) was performed. Randomized controlled trials were indentified from databases using the following search terms: migraine; calcitonin gene‐related peptide; calcitonin gene‐related peptide receptor antagonists; efficacy; safety, and telcagepant. The primary outcome measure was pain freedom 2 hours after first treatment. The secondary outcome measure was pain relief 2 hours after first treatment. Eight trials were included in the meta‐analysis (telcagepant = 4011 participants). The difference in pain freedom at 2 hours significantly favored telcagepant over placebo (odds ratio = 2.70, 95% confidence interval = 2.27–3.21, P < 0.001) and triptans over telcagepant (odds ratio = 0.68, 95% confidence interval = 0.56–0.83, P < 0.001). The difference in pain relief at 2 hours significantly favored telcagepant over placebo (odds ratio = 2.48, 95% confidence interval = 2.18–2.81, P < 0.001). The difference in pain relief at 2 hours did not significantly favor telcagepant over triptans or vice versa (odds ratio = 0.76, 95% confidence interval = 0.57–1.01, P = 0.061). These findings indicate that telcagepant can be effective for treating acute migraine. Calcitonin gene‐related peptide receptor antagonists represent a potentially important alternative means of treating acute migraine.     

The Impact of COVID-19 Surge on Clinical Palliative Care: A Descriptive Study From a New York Hospital System

ContextIn spring 2020, New York experienced a surge of patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) disease, as part of a global pandemic. There are limited data on populations of COVID-19–infected patients seen by palliative care services.ObjectiveTo describe a palliative care population at one New York hospital system during the initial pandemic surge.MethodsThis repeated cross-sectional, observational study collected data on palliative care patients in a large health system seen during the COVID-19 outbreak and compared it with pre-COVID data.ResultsPalliative service volume surged from 678 (4% of total admissions) before COVID-19 to 1071 (10% of total admissions) during the COVID-19 outbreak. During the outbreak, 695 (64.9%) of the total palliative patients tested positive for the virus. Compared with a preoutbreak group, this COVID-19–positive group had higher rates of male (60.7% vs. 48.6%, P < 0.01) and Latino (21.3% vs. 13.3%; P < 0.01) patients and less white patients (21.3% vs. 13.3%; P < 0.01). Our patients with COVID-19 also had greater prevalence of obesity and diabetes and lower rates of end-stage organ disease and cancers. The COVID-19–positive group had a higher rate of intensive care unit admissions (58.9% vs. 33.9%; P < 0.01) and in-hospital mortality rate (57.4% vs. 13.1%; P < 0.01) than the preoutbreak group. There was increased odds of mortality in palliative care patients who were COVID-19 positive (odds ratio = 3.21; 95% confidence interval = 2.43–4.24) and those admitted to the intensive care unit (odds ratio = 1.45; 95% confidence interval = 1.11–1.9).ConclusionDuring the initial surge of the COVID-19 pandemic in New York, palliative care services experienced a large surge of patients who tended to be healthier at baseline and more acutely ill at the time of admission than pre–COVID-19 palliative patients.     

Association of Musculoskeletal Pain With Sedentary Behavior in Public School Teachers: The Role of Habitual Physical Activity

BackgroundSedentary behavior has been associated with musculoskeletal pain in school teachers. However, our hypothesis is that physical activity practice could mitigate this association.AimThe aim of this study was to investigate the relationship of musculoskeletal pain with high screen-based sedentary behavior among public school teachers and whether physical activity could mitigate this relationship.MethodA sample of 246 teachers from 13 public schools were assessed (45.0 ± 10.4 years, 76.0% of women). Musculoskeletal pain was assessed using the Nordic Musculoskeletal Questionnaire, screen-based sedentary behavior was measured considering the sum of screen time in television, computer, and smartphone/tablet, and physical activity using the Baecke habitual physical activity questionnaire. Binary logistic regression was used to verify the associations between high screen-based sedentary behavior and musculoskeletal pain in school teachers (Model 1-unadjusted; Model 2-adjusted by age, sex, and socioeconomic status; Model 3-variables of Model 2 + adjusted by physical activity).ResultsHigh screen-based sedentary behavior was associated with pain in neck (odds ratio = 2.09; 95%confidence interval = 1.08-4.04), upper back (odds ratio = 2.21; 95%confidence interval = 1.07-4.56), and low back (odds ratio = 1.91; 95%confidence interval = 1.00-3.65). However, after inserting the variables, including physical activity, these associations were mitigated.ConclusionsHigh screen-based sedentary behavior was associated with musculoskeletal pain in public school teachers. However, this relationship was mitigated after the inclusion of confounding variables, including physical activity.     

超声内镜在胃黏膜下肿瘤诊断中的局限性*

目的评估超声内镜(EUS)对胃黏膜下肿瘤(SMTs)的诊断价值,并分析胃SMTs的EUS下特点。方法收集2008年9月-2016年12月614例于该院内镜中心经EUS检查后行内镜黏膜下剥离术(ESD)切除治疗的胃SMTs患者资料纳入回顾性研究。病变起源层次以ESD术中诊断为金标准,病变类型以术后病理学及免疫组化结果为金标准,统计EUS诊断的符合率,并分析EUS结果。结果 EUS对病变起源的诊断与ESD术中结果的符合率为91.25%,其中起源于黏膜肌层、黏膜下层和固有肌层的诊断符合率分别为66.67%、80.85%和94.50%;对病变类型的诊断与ESD术后病理结果的符合率为65.99%,其中胃肠间质瘤(GIST)、平滑肌瘤、异位胰腺和脂肪瘤的诊断符合率分别为91.85%、18.56%、79.76%和90.70%。结论 EUS能初步判断胃SMTs的起源层次与病变类型,可为内镜下治疗提供较为准确的依据,但对诊断平滑肌瘤、错构瘤、炎性纤维性息肉、类癌和纤维瘤等少见病变存在一定的局限性。因此,必要时应积极地切除病变,以明确诊断,防止恶变。     

内镜超声检查对溃疡性结肠炎的诊断价值探讨

目的探讨内镜超声检查对溃疡性结肠炎的诊断价值.方法对31例活动期溃疡性结肠炎行超声内镜检查,分析肠壁、肠旁淋巴结等影像学特征及与病变活动程度的关系.结果①病变区域管壁增厚,平均管壁总厚度为(6.62±0.58) mm.管壁各层次增厚率分别为:M 77.4%(24/31)、SM 93.5%(29/31)、MP 64.5%(20/31)、S 71.0%(22/31),其中81.8% MP层增厚见于Baron' Ⅳ级,明显高于Ⅱ级(0%)及Ⅲ级(33.3%)组(P<0.05).②管壁层次结构大多清晰可辨.77.4%出现M层异常变化,其中22.6%显示3层、54.8%为4层管壁声像图,前者均见于Baron' Ⅳ级,后者72.7%分布于Ⅳ级组,明显高于Ⅱ、Ⅲ级组(P<0.05).③6.5%黏膜下层内可见直径大于2 mm的脉管样低回声结构,54.8%发现息肉.④于58.1%肠壁旁发现炎性肿大的淋巴结,其分布与Baron'分级无关;未见脓肿或窦道等病灶.结论 EUS能够显示炎症侵袭肠壁的深度,与病变的严重程度相一致,有助于临床对病情及预后的判断和治疗方案的选择.     

The sonographic appearance of the normal gastric wall: an in vitro study

In order to evaluate the real number and anatomical correspondence of the ultrasonographically recognizable layers within the gastric wall, we used a high frequency (7.5 MHz) rotating transducer to examine five surgical specimens of the stomach suspended in a water bath. Five layers were always clearly distinguishable within the gastric wall, whose thickness was 3–6 mm. Fine needles and lancets were localized at the level of the 3^rd hyperchoic layer when inserted in the submucosa and in the 4^th hypoechoic layer when inserted in the muscolaris propria. Thin echogenic bands were always displayed on both sides of other homogeneous tissues (spleen, myometrium) suspended in water. On the basis of these findings and also taking in account the physical laws of ultrasound interactions with tissues, we conclude that the 1^st and the 5^th hyperechoic layers are partially generated by ultrasound reflection at the interface liquid/wall. The 2^nd hypoechoic layer corresponds to the deepest part of the mucosa; the 3^rd hyperechoic to the submucosa and the submucosa/muscularis propria interface and the 4^th hypoechoic layer to the muscularis propria.     

Lansoprazole-induced improvement of esophageal submucosal injury

The proton pumpvinhibitor, lansoprazole, is reported to have acid secretion inhibiting effect as well as anti-inflammatory effects such as inhibition of cytokine secretion from inflammatory cells. Clinically, excellent efficacy of lansoprazole is reported for not only gastric ulcer but also gastroesophageal reflux disease (GERD). Since GERD is categorized endoscopically into erosive esophagitis and non-erosive reflux disease, it is important to make accurate assessment of any improvement in the inflammatory process when using endoscopic ultrasonography (EUS) capable of visualizing the submucosal structure. We report here our experience in assessing the effect of treatment with lansoprazole on esophageal wall structure using EUS in patients with GERD. At baseline (before treatment), EUS showed abnormalities in the mucosa, submucosa and muscularis propria caused by inflammation, thickening of the entire esophageal wall and changes in the contractile properties of esophageal smooth muscles reflecting the effects of inflammation on the entire wall of the lower esophagus in reflux esophagitis regardless of whether it is erosive or endoscopically-negative. Treatment with lansoprazole resulted in normalization of esophageal wall structure and improvement of motility, suggesting that lansoprazole improves not only mucosal inflammation but also submucosal inflammation in GERD.     

单钳道内镜下荷包缝合术在胃底剥离术并发穿孔中的应用

目的观察使用单钳道内镜下荷包缝合法处理胃底间质瘤剥离时发生穿孔的闭合效果。方法 15例来源胃底固有肌层的间质瘤病例,瘤体长径1.5~3.0 cm,行内镜黏膜下剥离术(ESD)中发生穿孔,单钳道内镜下荷包缝合法闭合创面。结果 15例患者均成功闭合创面,耗时10~15 min,未出现严重并发症。结论单钳道内镜下荷包缝合法处理胃底ESD伴随的穿孔,方法简便有效。     

The Effect of the Pain Symptom Cluster on Performance in Women Diagnosed with Advanced Breast Cancer: The Mediating Role of the Psychoneurological Symptom Cluster

Background: Pain, depression, anxiety, sleep disturbances, and constipation were reported in different symptom clusters at different stages of breast cancer. Managing symptom clusters rather than individual symptoms can improve performance status. Aim: The study examined the effect of pain symptom cluster (pain and constipation) on performance when mediated by the psychoneurological symptom cluster (depression, anxiety, and sleep disturbances) using age as a moderator. Design: A secondary analysis. Settings: Palliative care center at a tertiary medical center in northeast Ohio. Participants: Eighty-six women diagnosed with advanced breast cancer. Method: A quantitative cross-sectional approach. Results: Ordinal logistic regression showed that pain symptom cluster did not have a significant mediation effect on performance. Odds ratio indicated that subjects with pain symptom cluster were 63% more likely to be bedridden (odds ratio = 1.63, confidence interval = .69-3.84). Women who reported pain symptom cluster were 5% more likely to have psychoneurological symptom cluster (odds ratio = 1.05, confidence interval = .400-2.774). Stratified analysis of age showed no differences in performance. Post-hoc analysis showed that the components of pain symptom cluster had a significant effect on psychoneurological symptom cluster (odds ratio: 3 [1.18-7.62]). Conclusions: Pain, constipation, depression, anxiety, and sleep disturbances were highly prevalent in women with advanced breast cancer. However, they tended to cluster in different symptom clusters. Although some findings were not significant, they all supported the direction of the tested hypotheses. Variations in symptom clusters research, including methodology, instruments, statistical tests, and chosen symptom cluster correlation coefficient, should be addressed.     

High frequency endosonography of gastrointestinal arteries: Potential and limitations defined in vitro

Objective: Severe arterial bleeding from the gastrointestinal (GI) wall usually arises from submucosal or subserosal arteries. Endosonography (EUS) is a method which can image small structures like GI wall vessels and, thus, has potential for improving the diagnosis and directing the therapy of vascular disorders of the β tract. Furthermore, ultrasonography is increasingly used in open and laparoscopic surgery to detect arteries, thereby possibly reducing bleeding complications. The aim of this study was to evaluate the ability of two different ultrasound (US) systems to image small arteries in the submucosa, subserosa and mesentery in vitro. Methods: A special system was used which allowed the ultrasound images to be precisely compared with histology of the same area of tissue. US images were made with an 8.5 MHz linear array and a 20 MHz single crystal US probe. Fifty measurements were obtained from 48 porcine and human GI arteries. All arteries were localized in the submucosa, subserosa or mesentery. Two of these arteries were also partly located in the mucosa and muscularis propria, respectively. Results: The arteries had an internal diaméter between 0.04 and 2.20 mm (median 0.25 mm) on histology. Both US systems could display arteries with a diameter as small as 0.1 mm, but arteries less than 0.20 mm in diameter were better resolved with the 20 MHz system than by the 8.5 MHz system. Arteries with diameters less than 0.1 mm could not be reliably distinguished from artifacts. Arterial lumens were anechoic, thus giving a good contrast to the echogenic submucosa and subserosal fat. The two arteries in the mucosa and muscularis propria could not be seen on US images due to their similar hypoechoic appearance. Conclusions: These findings indicate that small gastrointestinal arteries can be defined in vitro using ultrasound frequencies between 8.5 MHz and 20 MHz. Further studies with ultrasonography done in vivo are needed to define their potential clinical role.     

Endoscopic sonographic evaluation of the thickened gallbladder wall in patients with acute hepatitis

PURPOSE: Thickening of the gallbladder wall is often observed during abdominal sonographic examination in patients with acute hepatitis. However, there is rarely an opportunity for a histopathologic analysis of these structural changes. Endoscopic sonography (EUS) can accurately delineate the structure of the gallbladder wall and therefore may be useful for visualizing changes in the gallbladder wall in patients with acute hepatitis. Hence, we prospectively studied the ability of EUS to detect specific structural changes in the gallbladder wall in patients with acute hepatitis and examined the effect of high elevation of serum liver enzyme levels on the gallbladder wall. METHODS: A study group of patients diagnosed with acute hepatitis who had gallbladder wall thickening and a control group of patients without acute hepatitis or gallbladder disease underwent EUS between May 1, 1999, and June 1, 2002. EUS was used to measure the thickness of the gallbladder wall and to visualize each of its layers. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of the patients with acute hepatitis were measured at the time of the EUS examination. Statistically significant differences were determined using an independent t test and the chi-squared test. A p value of less than 0.05 was considered statistically significant. RESULTS: The acute hepatitis group comprised 28 men and 24 women with a mean age of 40.8 years. The control group comprised 25 men and 25 women with a mean age of 45.1 years. The mean gallbladder wall thickness +/- standard deviation in the acute hepatitis group (6.3 +/- 2.6 mm) was significantly greater than that in the control group (1.6 +/- 0.4 mm; p < 0.01). The mean thickness of the gallbladder wall for patients in whom both the AST and the ALT levels were 500 U/l or higher (7.0 +/- 2.6 mm) was significantly greater than that for patients with levels below 500 U/l (5.4 +/- 2.3 mm; p < 0.05). In the acute hepatitis group, EUS showed thickened, well-defined muscular and serosal layers of the gallbladder wall in 24 of the patients and a diffusely thickened gallbladder wall, in which each layer was ill defined, in the other 28 patients. The mean thickness of the gallbladder wall for patients with the pattern of ill-defined layers was significantly greater than that for the patients with the pattern of well-defined layers (p < 0.05). The pattern of ill-defined layers was more common among patients in whom the serum AST and ALT levels were at least 500 U/l than among patients with levels below 500 U/l (p < 0.05). CONCLUSIONS: We propose that gallbladder wall thickening in patients with acute hepatitis is associated with prominent changes in the muscular and serosal layers. Patients with highly elevated serum liver enzyme levels are more likely to have gallbladder wall thickening and disruption of planes between the muscular and serosal layers than are patients with normal liver enzyme levels.     

Effects of Parity and Breastfeeding Duration on Bone Density in Postmenopausal Women

PurposeThis study aimed to identify the effect of parity and breastfeeding duration and the occurrence of lumbar vertebral and femoral neck osteoporosis in Korean postmenopausal women.MethodsThis study analyzed the data of 1,770 women based on the 2010–2011 results of the Korea National Health and Nutrition Examination Survey. Extracted data concerning bone density included variables known to be associated with osteoporosis. Complex sample multivariate logistic regression analysis was conducted to determine whether parity and breastfeeding duration were associated with osteoporosis in postmenopausal women.ResultsParity was not associated with postmenopausal osteoporosis in the femoral neck or lumbar vertebrae; however, the risk of femoral neck osteopenia was significantly higher in women with a history of 12–24 months of breastfeeding than in women who breastfed for less than 12 months (odds ratio = 2.12, 95% confidence interval = 1.07–4.21). In women who breastfed for 24 months or longer, the risk of lumbar vertebral osteoporosis was significantly higher than in those who breastfed for less than 12 months (odds ratio = 2.73, 95% confidence interval = 1.18–6.32).ConclusionBreastfeeding duration may affect the occurrence of lumbar vertebral or femoral neck osteopenia or osteoporosis. Therefore, women who breastfeed for one year or more require education on the risk of bone loss and the need for preventive measures such as adequate calcium intake and physical exercise.     

High-resolution photoacoustic/ultrasound imaging of the porcine stomach wall: an ex vivo feasibility study

Photoacoustic (PA) imaging has become invaluable in preclinical and clinical research. Endoscopic PA imaging in particular has been explored as a noninvasive imaging modality to view vasculature and diagnose cancers in the digestive system. However, these feasibility studies are still limited to rodents or rabbits. Here, we develop a fully synchronized simultaneous ultrasound and photoacoustic microscopy system using two spectral bands (i.e., the visible and near-infrared) in both optical- and acoustic-resolution modes. We investigate the feasibility of imaging gastric vasculature in an ex vivo porcine model. The entire gastric wall, including the mucosa, submucosa, muscularis propria, and serosa, was excised from fresh porcine stomachs immediately followed by ultrasound and PA imaging being performed within a few hours of sacrifice. PA images of the mucosal vasculature were obtained at depths of 1.90 mm, which is a clinically significant accomplishment considering that the average thickness of the human mucosa is 1.26 mm. The layer structure of the stomach wall could be clearly distinguished in the overlaid PA and US images. Because gastric cancer starts from the mucosal surface and infiltrates into the submucosa, PA imaging can cover a clinically relevant depth in early gastric cancer diagnosis. We were able to detect mucosal vasculature in the entire mucosal layer, suggesting the potential utility of combined PA/US imaging in gastroenterology.     

Endoscopic ultrasound features of protein-losing gastropathy with hypertrophic gastric folds

BACKGROUND AND STUDY AIMS: We aim to clarify the endoscopic ultrasound (EUS) features of protein-losing gastropathy with hypertrophic gastric folds (PLGH), including Ménétrier's disease. PATIENTS AND METHODS: We analyzed the EUS and histologic findings in five patients who underwent both endoscopic ultrasonography and endoscopic resection. RESULTS: Histologically, we diagnosed one patient as having acute gastritis, three patients as having Ménétrier's disease, and the remaining patient as having hypertrophic lymphocytic gastritis (HLG). Helicobacter pylori was recognized in all but one patient. At EUS every patient was found to have giant gastric folds (13 to 20 mm in diameter), resulting from echogenic thickening of the mucosal layer with or without cystic components. Two patients who underwent eradication therapy of H. pylori showed both clinical and morphologic resolution. CONCLUSIONS: Echogenic thickening of the mucosal layer may be a characteristic EUS feature of protein-losing gastropathy with hypertrophic gastric folds, and H. pylori may be one of the causative agents.     

Isolated vasculitis of the stomach: a novel or rare disease with a difficult differential diagnosis

In up to 80 % of patients with vasculitis, signs of the disease are also seen in the gastrointestinal tract. However, no cases of exclusively gastric vasculitis have previously been reported. We report here the case of a 45-year-old woman with upper abdominal discomfort (no arthropathy), with gastroscopic and endoscopic ultrasound (EUS) findings that mimicked scirrhous gastric carcinoma. Gastroscopy revealed giant gastric folds and a suspicious antral ulcer (with histological findings suggesting chronic active pangastritis). EUS showed a concentric, thickened gastric wall (8 mm) with "pseudolamellation" and more than five enlarged lymph nodes in the paragastric region (lesser curvature). On the basis of suspected scirrhous gastric carcinoma, the patient underwent a four-fifths gastric resection of the altered parts of the gastric tissue. The postoperative course was uneventful. Histological examination of the specimen revealed severe obliterative panvasculitis of the stomach. During a 22-month follow-up period, no signs or symptoms of systemic primary or secondary vasculitis were found in the patient's medical history, symptoms, laboratory parameters, or imaging. This case shows for the first time that a specific gastric panvasculitis can occur, either as a preliminary stage of the condition or as a distinct manifestation of vasculitis associated with the stomach alone. Gastric resection appears to be indicated in patients with isolated obliterative gastric vasculitis, since it avoids the side effects of long-term immunosuppressive therapy and provides prognostic information that takes account of the differential diagnosis of scirrhous gastric carcinoma.     

Endorectal sonographic appearances of rectal MALT lymphoma, its response to therapy, and local recurrence

Endorectal sonography may significantly help to evaluate rectal lymphoma. We report the sonographic findings in a case of rectal non-Hodgkin's MALT (mucosa-associated lymphoid tissue) lymphoma, including the monitoring of response to therapy and confirmation of recurrence, in a 45-year-old man. On endorectal sonography of the rectal wall, the mucosa was markedly thickened to 1.1 cm and was diffusely hypoechoic and risen into multiple polypoid folds. The submucosa and muscularis propria appeared normal. Multiple lymph nodes were visualized in the perirectal fat; they were homogeneously hypoechoic, were round or oval, and ranged from 1.0 cm to 2.6 cm. Endoscopic biopsies revealed a grade I non-Hodgkin's MALT lymphoma. Following chemotherapy, endorectal sonography showed that the surface of the rectal mucosa had a smoother appearance and near-normal thickness, but lymph nodes, although smaller, remained visible in the perirectal fat. Four months later, endorectal sonography demonstrated a local relapse of disease, with significant thickening of the rectal mucosa and multiple lymph nodes visible in the perirectal fat. Following high-dose chemotherapy for the recurrence, endorectal sonography demonstrated a near-normal appearance of the rectal mucosa.     

超声内镜及内镜黏膜下剥离术对直肠类癌的诊疗价值

目的探讨超声内镜(EUS)对直肠类癌治疗的指导价值,及内镜黏膜下剥离术(ESD)对直肠类癌治疗的安全性及有效性。方法对临床考虑直肠类癌的患者进行EUS检查,根据EUS结果选择适合的治疗方案。结果 45例术前病理确诊的类癌病例,42例经ESD治疗,2例累及固有肌层及1例浸透浆膜层并伴有周围淋巴结转移者,经外科手术治疗。结论 EUS能够明确直肠类癌的大小、浸润深度、有无周围淋巴结肿大,对其治疗有较高的指导价值。对于小于20 mm直肠类癌,ESD是一种安全、有效的方法。     

肾囊性肿物超声造影征象诊断恶性肾囊性肿物的价值

目的 探讨肾囊性肿物超声造影征象对恶性肾囊性肿物的诊断价值.方法 对103例患者119个肾囊性肿物行超声造影,测量肿物囊壁、分隔厚度,记录肿物有无囊壁增厚(＞2 mm)、分隔增厚(＞2 mm)、囊壁强化、分隔强化、实性成分强化、分隔较多(囊腔数≥5)等征象.手术病理和随诊结果证实119个肾囊性肿物中良性64个,恶性55个.以手术病理和随诊结果作为金标准,计算囊壁增厚、分隔增厚、囊壁强化、分隔强化、实性成分强化、分隔较多等征象诊断恶性肾囊性肿物的敏感度、特异度、准确性、阳性预测值和阴性预测值并进行比较.结果 良、恶性肾囊性肿物囊壁厚度的M(QR)分别为0.22(0.10)cm、0.43(0.27)cm,差异有统计学意义(χ2=32.2989,P＜0.0001),分隔厚度的M(QR)分别为0.12(0.12)cm、0.36(0.25)cm,差异也有统计学意义(χ2=36.6528,P＜0.001).囊壁增厚、分隔增厚、囊壁强化、分隔强化、实性成分强化、囊腔数≥5诊断恶性肾囊性肿物的敏感度分别为90.91%、78.18%、96.36%、90.91%、67.27%、67.27%,特异度分别为34.38%、76.56%、1.56%、23.44%、87.50%、79.69%,准确性分别为60.50%、77.31%、45.37%、54.62%、78.15%、73.95%,阳性预测值分别为54.38%、74.14%、45.69%、50.51%、82.22%、74.00%,阴性预测值分别为81.48%、80.83%、33.33%、75.00%、75.68%、73.91%.囊壁增厚、囊壁强化、分隔强化诊断恶性肾囊性肿物的敏感度较高,但特异度较低;分隔增厚、实性成分强化、分隔较多诊断恶性肾囊性肿物的准确性较高.结论 肾囊性肿物超声造影征象中分隔增厚、实性成分强化、分隔较多对恶性肾囊性肿物有较好的诊断价值.将分隔厚度＞2 mm定义为分隔增厚能较好地鉴别良、恶性肾囊性肿物.     

Evaluation of the new giant-biopsy forceps in the diagnosis of mucosal and submucosal gastric lesions

In order to improve the diagnosis of gastric disorders on the basis of biopsy material, we devised larger biopsy forceps (5 mm X 2.5 mm in inside dimensions) which fit into the newer fibergastroscope, GIF-1T (Olympus). Samples from 116 cases yielded 276 specimens; 179 specimens (64.8%) showed the full-thickness of the mucosa with muscularis mucosae, and approximately one-third of the total specimens included a considerable amount of submucosal tissue, but none of them contained parts of muscularis propria. In 4 out of 36 gastric carcinoma cases there was inconsistency between endoscopic and histological recognition of the proximal border of carcinomatous infiltration. Differentiation between adenoma and IIa, and benign and malignant lymphoma were more feasible with our forceps. No complications apart from minor bleeding were seen.