肺脂肪瘤1例报道并文献复习

目的 分析肺脂肪瘤的流行病学特征及临床特点,提高临床医师对肺脂肪瘤的诊治水平.方法 报道宁波大学附属医院呼吸科1例经病理确诊支气管脂肪瘤病例并对国内54例肺脂肪瘤病例进行回顾性分析.结果 患者女性,57岁,因“咳嗽、咯痰2个月,发热3周”于2010年8月24日入院,当地医院考虑“肺炎”,给予抗菌药物治疗,疗效欠佳转入我院.入院后行纤维支气管镜检查发现左下叶开口处肿物,后转入胸外科手术治疗,确诊为支气管脂肪瘤.到目前为止,国内能检索到的确诊为肺脂肪瘤的病例共54例.54例患者包括男性44例,女性10例,平均年龄(51.7±11.6)岁,支气管内脂肪瘤44例,肺内脂肪瘤10例,48例患者存在症状,主要症状无特异性,包括咳嗽、咯痰、发热、气促、咯血.50例患者存在异常影像表现,肺不张26例,渗出或实变13例,肿块18例,CT扫描下肿块呈低密度灶,CT值范围在-83～-122 Hu之间.23例患者行纤维支气管镜检查,但仅有6例(26.1％)得到正确诊断.34例患者描述手术方式,其中3例进行内镜下切除,术后恢复良好.结论 肺脂肪瘤以中老年男性为主;胸部CT发现脂肪密度肿块,需考虑脂肪瘤;硬质支气管镜镜下切除为支气管腔内脂肪瘤首选的治疗方式,肺内脂肪瘤或支气管脂肪瘤已发生肺实质的不可逆损害应手术切除.     

支气管镜下高频电凝圈套加高频电凝治疗支气管脂肪瘤1例报道并文献复习

目的：了解支气管脂肪瘤的临床特征,提高对该病的认识。方法分析我科收治的1例经病理证实为支气管脂肪瘤患者的资料,并回顾性复习国内外相关的文献。结果患者男,78岁,表现为阻塞性肺炎伴咯血,胸部CT及三维重建提示脂肪瘤可能(CT 值为-100~-21 Hu),在全身麻醉下行支气管镜下高频电凝圈套加高频电凝切除术,术后支气管通畅,病理证实为脂肪瘤。结论支气管脂肪瘤为罕见的良性肿瘤,临床症状、体征无特异性,常表现为哮喘、阻塞性肺炎、COPD、肺癌等,误诊率达55.0%,确诊时间为11个月。诊断主要依靠胸部 CT 及三维重建和核磁共振成像,病理为确诊依据。治疗方法有外科手术和内镜下切除,切除的方法取决于肿瘤的大小和肺损伤的程度。镜下治疗支气管脂肪瘤是一项安全、有效、经济的治疗手段。     

气管镜下热消融联合冷冻切除术治疗气道良性肿瘤的临床分析

目的:总结分析气管镜下热消融联合冷冻切除术治疗原发气管、支气管良性肿瘤的应用价值。方法:总结北京友谊医院呼吸内科2010年至2012年间,6例原发气管/支气管良性肿瘤患者的临床表现、胸部CT、支气管镜下表现、病理类型及内镜下介入治疗方法及转归。结果:6例患者均为男性,病程在1个月~10年;病理类型包括:错构瘤3例,脂肪瘤1例、鳞状上皮乳头状瘤1例,肉芽肿1例。全部患者均在局麻联合静脉麻醉下进行气管镜下介入治疗手术,均采取热消融联合冷冻技术。所有病例术后气道完全开通,解除了气道梗阻。其中4例一次性手术清除病灶;1例因病灶分布广,分2次手术;1例因气道狭窄明显且狭窄部位位于声门下,分3次手术。术后无严重并发症,随访无复发。结论:气管镜下热消融联合冷冻治疗原发气管、支气管良性肿瘤疗效确切,简单、创伤小并安全。     

纤维支气管镜检查与胸部CT对气管、支气管结核的诊断价值

目的评价纤维支气管镜检查与胸部CT对气管、支气管结核的诊断价值。方法回顾性对比分析我科2003和2004年度收作的气管、支气管结核病例81例,其中男性24例,女性57例；年龄14～70岁,平均37．3岁。全部病例均经细菌学或病理学确诊、经纤维支气管镜检查分型并与胸部CT     

40例纵隔及支气管旁淋巴结结核CT及气管镜检查特点分析

对40例经手术病理及气管镜活检病理检查等确诊的纵隔淋巴结结核患者的CT及气管镜检查特征进行回顾性分析.结果 CT示病灶不均匀强化、环形强化、分隔样强化,液化及钙化较少;气管镜示支气管腔内大小不等、高低不平结节灶,部分溃破有乳白色豆渣样脓性物,或伴管腔肿胀阻塞狭窄.认为纵隔及气管旁淋巴结结核在CT扫描及气管镜下有特征性表现,此有利于临床诊断与鉴别诊断.     

纤维支气管镜联合胸部CT对周围型肺癌的诊断价值

目的探讨胸部CT联合纤支镜在周围型肺癌中诊断和肺癌分期中的价值。方法24例肺癌患者均做胸部CT及纤支镜检查,9例加做经皮肺穿刺针吸活检术,加上手术标本,24例患者均取得病理标本。结果CT“支气管征”阳性的7例中5例经纤支镜活检阳性,阳性率70％。肿瘤直径〈3cm的经纤支镜活检均为阴性。经纤支镜活检阳性的6例中,肿瘤位于肺中心5例,肺外周仅1例。经纤支镜活检阴性的18例中13例肿瘤位于肺外周,5例位于肺中心。4例胸部CT示结节状改变,手术证实为腺癌。24例患者的胸部CT中均未发现有大气道的浸润,但纤支镜检查发现有2例肿瘤近端在段支气管开口,1例叶支气管近端。结论胸部CT阳性“支气管症”能预测经纤支镜活检的阳性率。肺癌新国际TNM分期标准,使腔内病变的发现更趋重要,故周围型肺癌联合纤支镜检查是必要的。     

支气管结核248例临床分析

目的 探索气管、支气管结核的临床特征及诊断治疗手段。方法 分析1993年1月至2000年10月248例气管支气管结核住院病例资料临床表现、影像学、纤支镜检查结果。结果 248例患者中15－34年龄组青年女性明显高于其它组占69.2%(72/104)。左侧支气管病变多于右侧。影像学、纤支镜、实验室检查确诊234例，肺切除术后病理确诊14例。全组病例均予规范抗结核化疗，其中合并雾化治疗72例。经纤支镜支气管腔内给药的26例有效率84.6%。外科治疗47例。结论 纤支镜检查是诊断气管支气管结核最重要的方法。在实施规范抗结核化疗同时合并雾化及经纤支镜支气管内给药治疗，是改善临床症状，减轻或消除支气管狭窄的有效方法。对不同逆结核性支气管狭窄、肺不张及严重肺功能损毁患者应及时外科治疗。     

支气管结核248例临床分析

目的 探索气管、支气管结核的临床特征及诊断治疗手段。方法 分析248例1993－2000年住院气管支气管结核病例资料临床表现、影像学、纤支镜检查，治疗结果。结果 248例患者中15－34年龄组青年女性明显高于其它组占69．2％（72／104）。左侧支气管病变多于右侧。影像学、纤支镜、实验室检查确诊234例，肺切除术后病理确诊14例。全组病例均予规范抗结核化疗，其中并用雾化治疗72例。经纤支镜支气管腔内给药26例有效率84．6％。外科治疗47例。结论 纤支镜检查是诊断气管支气管结核最重要的方法。在实施规范抗结核化疗同时并用雾化及经纤支镜支气管内给药治疗，是改善临床症状，减轻或消除支气管狭窄的有效方法。对不可逆结核性支气管狭窄、肺不张及严重肺功能损毁患者应及时外科治疗。     

支气管结核248例临床分析

目的　探索气管、支气管结核的临床特征及诊断治疗手段。方法 分析248例1993～2000年住院气管支气管结核病例资料临床表现、影像学、纤支镜检查,治疗结果。结果 248例患者中15～34年龄组青年女性明显高于其它组占69.2% (72/104)。左侧支气管病变多于右侧。影像学、纤支镜、实验室检查确诊234例,肺切除术后病理确诊14例。全组病例均予规范抗结核化疗,其中并用雾化治疗72例。经纤支镜支气管腔内给药26例有效率84.6%。外科治疗47例。结论 纤支镜检查是诊断气管支气管结核最重要的方法。在实施规范抗结核化疗同时并用雾化及经纤支镜支气管内给药治疗,是改善临床症状,减轻或消除支气管狭窄的有效方法。对不可逆结核性支气管狭窄、肺不张及严重肺功能损毁患者应及时外科治疗。     

肺结核合并支气管结核97例临床分析

目的探讨肺结核合并支气管结核的临床特点。方法回顾性分析97例肺结核合并支气管结核临床资料。结果临床以咳嗽（82．5％）、咳痰（80．4％）、发热（45．4％）、不同程度咯血或血丝痰（23．7％）等为主要症状，胸部CT以肺不张或膨胀不全（44．2％）及浸润增殖性病灶（37．9％）为主要表现，并可见支气管狭窄阻塞、支气管扩张、支气管播散、支气管充气征、纵隔淋巴结增大、纵隔淋巴结钙化等表现，痰涂片或培养检查抗酸杆菌阳性率较高（63．9％），尤其在多叶段浸润增殖病灶患者中其阳性率高达83．3％。纤支镜检查以主支气管及叶支气管开口受累显著（64．8％），多气管支气管受累患者达81．4％，且多种支气管镜下表现类型并存，纤支镜刷检抗酸杆菌、组织活检阳性率分别为55．9％、69．4％。接受纤支镜介入治疗的患者仅有18例，其中6例支气管狭窄闭塞并肺不张患者行气管镜下支气管球囊扩张术治疗，5例支气管狭窄好转。结论肺结核合并支气管结核患者临床表现无特异性。胸部CT对观察支气管损伤及淋巴结病变能提供较大帮助。气管镜检查仍为其重要诊断手段，镜下可见多气管支气管受累，且镜下表现类型相互重叠。球囊扩张术可有效改善支气管狭窄。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.