恶性肿瘤合并头颈部真菌感染的临床与病理学观察

目的 探讨恶性肿瘤合并头颈部真菌感染的临床与病理特点.方法回顾分析21例恶性肿瘤合并头颈部真菌感染患者的临床和病理资料;用HE染色、过碘酸-雪夫(PAS)染色和环六亚甲基四胺银(GMS)染色显示组织病变特点及真菌的形态特征,用黏蛋白5B(MUC5B)抗体免疫组织化学EnVision法染色标记真菌;13例组织标本进行了真菌培养.结果患者发病年龄12～72岁(中位年龄48岁),男性17例,女性4例.病理学检查证实合并侵袭性真菌性鼻窦炎(IFS)有8例(38.1%),其中波及眶内者6例(28.6%),侵入颅内1例;原发疾病为白血病(7例)及鼻咽癌(1例);病原真菌为接合菌(5例)和曲霉菌(3例),均有化疗或放疗及使用抗生素的病史.其余13例真菌感染发生于鼻腔鼻窦、咽喉及腭部原发肿瘤的坏死组织内,病原真菌主要为曲霉菌(6例)和念珠菌(4例),7例有放疗等治疗史.真菌培养结果9例阳性(9/13).随访病例14例,死亡6例.结论 恶性肿瘤可合并头颈部真菌感染,以IFS最为多见,好发于白血病化疗后,易累及眼眶,预后较差;病原真菌的类别在IFS以接合菌和曲霉菌多见;病理学检查仍然是尽快确定诊断及初步鉴别常见接合菌和曲霉菌类别的一个重要手段.     

108例肺结核合并糖尿病的临床分析

目的探讨肺结核合并糖尿病患者的临床特点以及血糖控制情况对抗结核疗效的影响。方法回顾性分析临床资料较完整的108例肺结核合并糖尿病患者以及30例单纯肺结核患者的临床资料,以抗结核治疗前后结核病灶范围、晨痰结核菌以及空洞的变化为评价指标,分析肺结核合并糖尿病患者,糖尿病病情的控制与肺结核临床转归的关系。结果在血糖控制理想的患者中（I组）,结核病灶吸收好转率、肺结核痰菌阴转率以及空洞缩小率或关闭率分别为94.3%、100%和90%;在血糖控制尚可的患者中（Ⅱ组）,结核病灶吸收好转率、肺结核痰菌阴转率及空洞缩小率或关闭率分别为85.4%、92.3%和83.3%;在血糖控制差的患者中（Ⅲ组）,结核病灶吸收好转率、肺结核痰菌阴转率及空洞缩小率或关闭率分别为44%、73.3%和42.9%;在对照组患者中（Ⅳ组）,结核病灶吸收好转率、肺结核痰菌阴转率及空洞缩小率或关闭率分别为96.7%、100%和100%。经χ2检验,I、Ⅱ、Ⅳ组间差异均无统计学意义（P〉0.05）。而I、Ⅱ、Ⅳ组分别和Ⅲ组比较,结核病灶吸收好转率与空洞缩小率或关闭率差异有统计学意义（P〈0.01）。结论糖尿病对肺结核抗结核治疗效果有负面影响,良好的血糖控制可能改善抗结核治疗的疗效。     

妊娠合并系统性红斑狼疮13例临床分析

目的探讨妊娠合并系统性红斑狼疮（SLE）的临床特点、治疗及妊娠结局。方法回顾分析13例妊娠合并SLE患者的临床资料。结果13例孕妇除1例自行要求孕26w引产外，余12例全部顺产，胎儿成活，无畸形。结论SLE患者妊娠及分娩可使原有病情恶化，SLE对胎儿、婴儿也可产生不利影响。因此应选择在缓解期受孕，并在孕期及产后继续应用泼尼松来预防SLE恶化、控制SLE活动，争取良好妊娠结局。     

股骨颈骨折患者并发股骨头坏死的预后相关影响因素

创伤引发的股骨颈骨折是临床上常见的骨科疾病之一,而其后续发生的以股骨头缺血坏死为代表的并发症是导致患者出现下肢运动功能障碍的主要原因之一。目前对于创伤后股骨颈骨折具体的损伤及修复机制仍不甚明了,因此研究股骨颈骨折后患者身体的各项指标及临床上针对的治疗措施对预后产生的影响,可为预测股骨颈骨折患者未来的预后打好基础,并为采取相应的干预手段提供思路。目前主要认为创伤后股骨颈血供不足和相关炎性重建反应是创伤性股骨头坏死的主要作用机制,而作用于相关机制的因素则被认为是其可能的危险因素。本文整理了近年来对于股骨颈骨折后续发生坏死相关影响因素的报道。学界主要认为受伤原因、Garden分型等骨折分型方式、内固定方式及复位质量等因素被认为是导致预后不良的可能危险因素。     

股骨颈骨折复位内固定后股骨颈短缩的发生率及相关因素

文题释义：股骨颈骨折复位内固定：股骨颈骨折是临床最为常见的一种骨折类型,约占全部髋部骨折的50%。空心钉内固定依然是临床上治疗股骨颈骨折最常用的方式,且取得了较满意的临床疗效,术后股骨头坏死和骨折不愈合的发生率呈明显下降趋势。 股骨颈短缩：空心钉内固定治疗后,部分患者术后可能出现股骨颈短缩的现象,甚至造成患者术后髋关节功能障碍的发生。 背景：空心钉内固定目前是临床上治疗股骨颈骨折最常用的方式,但部分患者术后可能出现股骨颈短缩的现象,甚至造成患者术后髋关节功能障碍的发生。 目的：探讨股骨颈骨折复位内固定后股骨颈短缩的发生率、临床特点、预后转归及相关影响因素。 方法：回顾性收集2012年1月至2017年3月成都地区3家骨科医院采用空心钉内固定治疗并获得完整术后随访信息的111例股骨颈骨折患者作为研究对象,所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。以术后股骨颈短缩作为预后观察指标,记录患者股骨颈短缩的发生率、发生时间及主要临床特点;采用单因素卡方检验分析性别、年龄、Garden分型、Garden指数、骨密度T值、Singh指数、受伤至手术时间、负重时间等因素与术后股骨颈短缩的相关关系,再将有统计学意义的因素纳入多因素Logistic回归模型分析。 结果与结论：①股骨颈短缩发生率为48.6%(54/111),其中股骨颈短缩10-19 mm的发生率为31.5%(35/111)、股骨颈短缩≥20 mm的发生率为5.4%(6/111);②股骨颈短缩的发生时间主要集中在术后6个月内,占76%;③股骨颈短缩的临床症状主要包括下地负重时疼痛、髋关节活动受限和跛行,股骨颈短缩的临床表现分析结果显示,颈短缩组以中度疼痛为主(67%),无短缩组以无疼痛/轻度疼痛为主(86%);颈短缩组髋关节活动受限的发生率高于无短缩组(68% vs. 21%),颈短缩组患者跛行的发生率高于无短缩组(61% vs. 18%),差异均有显著性意义(P均< 0.05);④单因素及多因素Logistic回归模型分析表明,骨折Garden分型为Ⅲ,Ⅳ型、Garden指数为Ⅲ,Ⅳ级、骨密度T值≤-2.5、负重时间≤2个月是股骨颈骨折复位内固定后发生股骨颈短缩的独立危险因素,说明股骨颈骨折空心钉内固定后存在很高的股骨颈短缩发生风险,而发生时间主要集中术后6个月内。 ORCID: 0000-0002-4430-4394(牟帅) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

Head and neck rhabdomyosarcoma: follow-up results of four cases and review of the literature

Head and neck rhabdomyosarcoma (HNRMS) is exceedingly rare and poorly documented. The difficult diagnosis often causes a poor prognosis and high mortality. Hence, we report 4 cases of HNRMS and their follow-up outcomes, and review the clinicopathological features of this rare tumor. The 4 patients ranged in age from 5 to 29 years. Among them, 3 patients had a good prognosis after combination of radiotherapy and chemotherapy or surgery alone. Another patient survived for only 3 months after diagnosis without therapy. Deeply insight into HNRMS might improve the ability of diagnosis and treatment for this disease.     

头颈部肿瘤患者上呼吸道感染微生物检测及结果分析

目的：分析头颈部肿瘤患者放/放化疗期间咽试子培养和药敏结果。方法：回顾性分析229例患者503次咽试子培养、药敏结果及抗生素应用情况。结果：229例患者中培养阳性133例(58.1%),细菌培养阳性98例(42.8%),真菌培养阳性72例(31.4%)。其中13例患者双重细菌感染,2例患者三重细菌感染,37例患者细菌真菌双重感染。结论：头颈部肿瘤放/放化疗期间上呼吸道感染率高,以条件致病菌为主。治疗期间应重视致病微生物培养,合理应用抗生素,并积极预防真菌感染。     

肱骨近端解剖钢板治疗肱骨外科颈骨折36例临床分析

目的评价应用肱骨近端解剖型钢板治疗肱骨外科颈骨折的方法及疗效。方法回顾性分析肱骨近端解剖型钢板治疗肱骨外科颈骨折36例临床资料。结果本组手术过程顺利,无神经、血管损伤,住院期间无感染等并发症发生。36例中31例获门诊随访,随访时间6～24个月,平均12个月,获得随访的患者骨折术后均I期愈合,按Neer肩关节评价标准,优及满意率为93.5%。结论肱骨近端解剖型钢板治疗肱骨外科颈骨折是一种有效的方法。     

Fine needle aspiration of pleomorphic lipoma of the neck: Report of two cases

Pleomorphic lipoma is a rare lipocytic neoplasm that most commonly occurs in the head and neck region in middle‐aged to elderly men. Clinically, it presents as a slow‐growing, wellcircumscribed subcutaneous mass. Histopathologically and cytogenetically, it has some features overlapping with other benign and malignant tumors, such as benign spindle cell lipoma, atypical lipomatous tumor, liposarcoma, and malignant fibrous histiocytoma. However, cure rates are high when pleomorphic lipoma is treated with complete surgical excision with clear margins. Therefore, an accurate preoperative diagnosis is very important for proper treatment. Due to the rarity of this tumor, few cases diagnosed by cytology have been reported in the English literature. Here, we report two cases of pleomorphic lipoma, the diagnoses of which were suggested on fine needle aspiration biopsies and subsequently confirmed by surgical excisions. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Morphometric parameters of the radial neck: an anatomical study

Introduction The purpose of this study was to describe the anatomy of the intramedullary canal of the radial neck for stem design of radial head prostheses. Methods Radial neck measurement was performed from the proximal edge of the radial tuberosity to the distal border of the articular surface on 40 macerated proximal radii using X-rays and Optosil imprints of the intramedullary canal. Radial neck to shaft angle was measured under image intensification. Results The neck length was 13.3 mm (range 8.0–20.0 mm) measured on X-rays and 13.5 mm (range 9.9–18.8 mm) on Optosil imprints. Concerning the neck’s intramedullary canal we obtained a minimum diameter of 9.7 mm (range 6.3–16.4 mm) on X-ray. Corresponding Optosil imprints had a mean diameter of 11.6 mm (range 6.6–18.6 mm) at their proximal end, 10.5 mm (range 5.5–16.3 mm) in the middle and a minimum of 9.8 mm (range 6.0–16.9 mm) at the distal end. Differences between left and right sides were not significant between X-ray and Optosil imprints, nor between left X-ray and right imprints and vice versa at a P-level of 0.001. Radial neck to shaft angle was 167.8° (range 160.5–178°) measured under image intensification at a rotation angle of 58.6° (range 50–70°) supination. Conclusion Geometry of the radial neck’s intramedullary canal has been described for stem design. The minimum diameter was seen at the distal end, just proximal to the radial tuberosity. A forearm rotation of 58.6° to full supination should be considered during implantation of monopolar prostheses. The wide variety of lengths and diameters complicates standard prosthetic design, but ipsilateral and contralateral X-rays can be useful for preoperative stem size calculation.     

Infantile Rosai-Dorfman disease: an unusual case of neck swelling and a literature review

Rosai-Dorfman disease (RDD) is a benign, rare histiocytic disorder presenting as a wide clinical spectrum, which mainly affects bilateral dilated lymph node enlargement. This study aimed to show an infantile RDD and review the clinicopathologic features, imaging, and histological features of RDD, including pitfalls in diagnosis. We report here an infant who had a 3-month history of painless bilateral cervical masses progressed to tracheal compression. Postoperative immunohistochemical results with positive characteristic staining of CD68 and S-100, negative for CD1a, which helped to determine the diagnosis. This peculiar case is the youngest case of RDD presenting with painless massive lymph node progressing to severe dyspnea due to tracheal compression. The optimal treatment still remains challenging. Future research should focus more on etiology and pathogenesis of RDD, especially relapsing cases.     

怀化地区妊娠期肝内胆汁淤积症158例临床分析

目的探讨妊娠期肝内胆汁症（ICS）患者临床症状、肝功能损害与母儿预后的临床关系，降低围产儿的发病率及死亡率。方法对5年来收治的158例妊娠期肝内淤积症（ICP）患者的临床症状、肝功能损害及母儿预后进行回顾性分析。结果临床症状重、肝功能损害程度大的，其胎儿宫内窘迫、宫内发育迟缓等并发症加重，母亲肝功能恢复缓慢。结论妊娠期肝内胆汁淤积症（ICP）患者可并发较重的肝功能损害，应加强产前检查，定期进行胎盘功能测定、胎儿电子监护仪的监测，降低围产儿的发病率及死亡率。     

Carcinomas arising in multilocular thymic cysts of the neck: a clinicopathological study of three cases

AIMS: To report three cases of primary carcinoma of the neck arising in multilocular thymic cysts (MTC). METHODS AND RESULTS: The patients were three men aged 47, 50 and 52 years who presented with a painless neck mass of several weeks' duration. The patients had no history of previous surgical procedures or of malignancy elsewhere. The tumours in all three patients were located on the right lateral side of the neck; all patients underwent complete surgical resection of the mass. Grossly, the tumours were cystic and measured between 20 and 30 mm in greatest diameter. Histologically, the tumours showed cyst walls lined by squamous epithelium. The cyst walls contained prominent germinal centres with lymphoid hyperplasia, cholesterol cleft granulomas, and scattered keratinized structures reminiscent of Hassall's corpuscles. In addition, a neoplastic cellular proliferation composed of round to oval cells arranged in sheets and originating from the lining of the cystic structures was present. The neoplastic cells showed moderate amounts of eosinophilic cytoplasm, round nuclei, and, in some areas, prominent nucleoli. Mitotic figures were easily found, and cellular pleomorphism was present in several areas. In two cases the tumours showed features of basaloid carcinoma of the thymus, while in one case the pattern was that of squamous cell carcinoma. Immunohistochemical studies for keratin showed a strong positive reaction in the tumour cells, while leucocyte common antigen strongly stained the lymphoid background. Follow-up information obtained in two patients showed them to be alive 6 months after initial diagnosis. One patient was lost to follow-up. CONCLUSION: The cases described here represent an unusual variant of carcinoma arising in multilocular thymic cyst in the neck region.     

脐带绕颈181例临床分析

目的探讨脐带绕颈的发生原因、诊断方法、产程处理及对围产儿的影响。方法选择脐带绕颈181例进行回顾性分析。结果脐带过短无1例发生脐带绕颈;脐带绕颈>3周者,脐带过长组明显多于脐带正常组(P<0.01),脐带绕颈的胎儿宫内窘迫率为25.41%,窒息率为11.60%,两组比较均P<0.01。脐带绕颈组自然分娩率明显低于对照组(P<0.01),阴道手术产与剖宫产均高于对照组(P<0.01)。结论脐带绕颈与脐带长度有一定的关系,脐带过长是导致脐带绕颈的基本原因。脐带绕颈会明显增加胎儿窘迫、新生儿窒息的发生率。     

艾滋病合并马尔尼菲青霉病2例诊断分析

目的 提高艾滋病合并马尔尼菲青霉病的诊断率。方法 分析2例明确诊断为艾滋病合并马尔尼菲青霉病病例的临床及病理资料并复习相关文献。结果 艾滋病合并马尔尼菲青霉病以“发热、淋巴结肿大、肺部阴影”为主要临床表现;淋巴结病变主要为“淋巴细胞显著减少,淋巴结内组织细胞增生并见大量类圆形病原体,少数为腊肠状病原体,偶见横膈,胞质嗜酸性,核弱碱性。结论 HIV主要破坏CD4阳性T细胞,导致机体免疫功能下降而感染马尔尼菲青霉菌;马尔尼菲青霉病又成为艾滋病的表征之一。因此,有发热、咳嗽、淋巴结肿大、淋巴细胞数减少、双肺部阴影的患者要考虑艾滋病合并马尔尼菲青霉病感染的可能。     

股骨颈内固定螺钉构型的解剖影像分析

目的 根据影像解剖图像分析探讨股骨颈骨折3枚螺钉内固定的最优螺钉构型。方法 自2017年1月至2月,在安吉县人民医院医学影像信息系统（PACS）中回顾性选择15例正常成人双侧(30根)股骨行三维CT重建,其中男8例,女7例;年龄28～63岁,平均(43±8.5)岁。于股骨颈中心轴线垂直方向在颈中部显示股骨颈截面（FNS),经图像重叠获得其在股骨转子外侧壁的投影。在股骨颈截面内模拟3种螺钉构型：以股骨颈截面长轴为中线的等边三角形构型（IET-FNS组）、股骨冠状轴为中线的等边三角形构型（IET-PF组）和股骨颈截面内的钝角三角形螺钉构型（OT组）。观察螺钉间距离、螺钉距股骨颈截面中心距离、螺钉工作面积与股骨颈截面积比。结果 螺钉间的距离：OT组（5.96±0.37）cm;IET-FNS组（4.74±0.39）cm。IET-PF组（4.58±0.39）cm;螺钉与股骨颈截面中心点距离：OT组（3.43±0.18）cm;IET-FNS组（2.81±0.17）cm;IET-PF组（2.72±0.14）cm。螺钉面积与股骨颈截面积比：OT组（0.31±0.01）;IET-FNS组（0.21±0.02）;IET-PF组（0.16±0.01）。OT组3项测量指标值均较大于其他两组,差异有统计学意义（P＜0.05）。结论 从影像解剖学分析,钝角三角形螺钉构型在观察指标螺钉间距离,螺钉距股骨颈截面中心距离、螺钉工作面积与股骨颈截面积比有优势,可能是股骨颈骨折3枚螺钉内固定的理想构型,但需要进一步的生物力学测试证实。     

Metaplastic carcinoma of the breast: fine-needle aspiration cytology of seven cases

We describe the cytomorphology of seven cases of metaplastic carcinoma of the breast studied by fine-needle aspiration cytology and by histology. All seven cases contained foci of ductual adenocarcinoma. This finding was combined with heterologous mesenchymal elements in four cases, a spindle-cell pattern of growth in one case, and extensive squamous-cell metaplasia in two cases. Both carcinomatous and metaplastic components were present on smears in four cases (57%). Thus in three cases (43%), the diagnosis was not possible on smear material alone. Differential diagnostic considerations are discussed.     

Cytological evaluation of head and neck tumors in children--a pattern analysis

A total of 135 pediatric head and neck tumors diagnosed in our institute were reviewed with a view to elucidate the overall cytological patterns and analyze the important cytological features. Ninety-four tumors (69.6%) were aspirated for a primary diagnosis, and in 41 (30.4%) cases, fine-needle aspiration cytology was performed to document relapse, recurrence or a metastasis. Among the 94 tumors aspirated for a primary diagnosis, 66 cases (70.2%) were accurately diagnosed, in 22 cases (23.4%) a broad working diagnosis was offered, and 6 cases (6.4%) were misdiagnosed. The accuracy rate was higher (79.3%) when relapse-recurrent and metastatic tumors were included. The smears were broadly divided into six patterns, viz. round cell, epithelial, anaplastic, giant cell, mixed inflammatory, and spindle cell patterns. The round cell pattern was the most frequent one encountered in this group. The cytological features that stood the test of variability were lymphoglandular bodies and a noncohesive cell population in hematolymphoid malignancies, pale chromatin and cytoplasmic vacuoles in primitive neuroectodermal tumor/Ewing's sarcoma (PNET/ES), neuropil and rosettes in neuroblastoma, and plasmacytoid rhabdomyoblasts in rhabdomyosarcoma. A fairly good accuracy was seen in the diagnosis of metastatic undifferentiated carcinoma and anaplastic lymphoma, but the giant-cell and spindle-cell tumors continued to pose a problem in diagnosis. Ancillary techniques such as immunocytochemistry and electron microscopy applied in limited cases helped evaluate Langerhans cell histiocytosis, alveolar rhabdomyosarcoma, and the PNET/ES family of tumors.     

甲状腺手术新麻醉点与颈深部结构的关系

目的：研究甲状腺手术新麻醉点与颈深部结构的关系。方法：３０侧成人标本，分层解剖观察新麻醉点与颈前部深层周围结构的毗邻关系，测量了主要神经血管距麻醉点的距离。结果：注射５ｍｌ染液（浅层３ｍｌ，深层２ｍｌ）着色的结构有胸锁乳突肌前缘、肩胛舌骨肌上腹、胸骨甲状肌上部、甲状舌骨肌下部；颈袢、颈动脉鞘前壁、甲状腺上动、静脉；喉上神经喉外支和甲状腺侧叶上极。结论：①５ｍｌ组迷走神经、颈交感干、膈神经、臂丛和喉返神经均未着色；②１０ｍｌ组（浅深层各５ｍｌ）迷走神经、颈交感干轻染。膈神经和颈神经根未着色     

股骨颈内固定系统固定股骨颈基底部旋转截骨的有限元分析

目的 采用有限元分析法比较股骨颈内固定系统（FNS）和空心螺钉作为治疗股骨头坏死的旋转截骨术中内固定装置的生物力学特性。方法 采用虚拟有限元建立中日友好医院分型L2型股骨头坏死模型,模拟前旋90°和后旋180°的旋转截骨术,分别模拟植入FNS（FNS组）及空心螺钉（空心螺钉组）,分析股骨近端截骨块、内固定装置、坏死区的应力分布及位移和股骨的位移。结果 前旋90°和后旋180°模型中,FNS组股骨近端截骨块、坏死区的应力和股骨近端截骨块、内固定装置、坏死区、股骨的位移均小于空心螺钉组。FNS组股骨近端截骨块和坏死区的应力峰值比空心螺钉组减少明显,近端截骨块应力峰值减小47.45%和13.64%,坏死区应力峰值减少44.96%和35.52%。结论 与空心螺钉相比,无论截骨后向前旋90°还是向后旋180°,FNS提供了更好的生物力学稳定性。