Diffuse lymphoid follicles of the colon associated with colonic carcinoma

In four patients aged 59-75 years, colonic carcinoma was associated with diffuse lymphoid follicles in the colon. In one case, the prominence and distribution of the lymphoid follicles corresponded to the progression and regression of the tumor bulk. It is extremely unusual to demonstrate lymphoid follicles, particularly diffuse, on barium enema in patients in this age range. The colonic carcinomas and lymphoid follicles are directly related, possibly representing an immune response.     

结肠癌中BTG3蛋白表达及临床意义

目的研究BTG3蛋白在结肠癌中的表达情况及其临床意义。方法选取2013—2014年手术切除的结肠癌石蜡标本为观察组(n=63),以同一患者癌旁(距原发灶≥5 cm)非肿瘤组织石蜡标本作为对照组(n=63)。应用免疫组织化学染色方法,比较两组中BTG3蛋白表达情况,分析其表达与临床特征的相关性。结果 BTG3蛋白主要定位于细胞浆,观察组阳性表达率(47.6%)低于对照组(81.0%),差异有统计学意义(P<0.01)。在结肠粘液腺癌中,BTG3蛋白未见阳性表达,而结肠腺癌中,其阳性表达率为52.6%,差异有统计学意义(P<0.05)。BTG3蛋白在结肠癌组织中的表达水平与组织学类型(r=-2.307,P<0.05)及组织学分级(r=-0.259,P<0.05)呈负相关。结论 BTG3蛋白在结肠癌组织中呈低表达,与结肠癌患者的肿瘤组织学类型和组织学分级关系密切,其表达水平可作为临床结肠癌诊治及判断预后的辅助指标之一。     

Nodular lymphoid hyperplasia of the colon associated with dysgammaglobulinemia.

A case of dysgammaglobulinemia associated with nodular lymphoid hyperplasia of the colon is reported. The patient had typical immunoglobulin deficiency, diarrhea, recurrent respiratory infections, Giardia lamblia in the stool, and lymphoid hyperplasia of the small intestine. His barium enema showed diffuse submucosal nodules. Rectosigmoid biopsy confirmed nodular lymphoid hyperplasia. The similar findings on barium enema in this entity and in lymphosarcoma are stressed.     

Sonographic detection of large spontaneous spleno-renal shunts and its clinical significance

The ultrasonographic findings of large spleno-renal shunts seen in five patients with liver cirrhosis and confirmed by CT and/or portography, are described. These spleno-renal shunts were seen in the left inter- or subcostal sections as transonic, mass-like lesions located between the splenic hilum and the left kidney, and by continuous scanning, they were found to be part of a tortuous, large tubular structure. Oesophageal varices were absent or minimal in these patients, and none of them had ever bled.     

Chronic lymphoid leukemia of the colon. Apropos of a case

The authors describe a rare case of chronic lymphocytic leukemia of the colon which they observed. Particular emphasis is placed upon the problem of differential diagnosis as presented by this affection.     

大肠癌不同部位扫描电镜观察及其临床意义

目的采用扫描电镜对大肠癌的表面微细变化进行观察。方法对肿瘤不同部位及肿瘤边缘5cm的粘膜标本进行常规电镜制备处理c结果癌细胞表面有两种类型：一种具有不典型微绒毛，一种没有微绒毛，呈颗粒状。在距肿瘤边缘5cm处，即可见到结肠粘膜上皮细胞表面微绒毛出现不典型的倾向。结论以上变化说明癌肿的扩展增大有可能是由于癌周边组织增生，逐渐移行转变为癌组织，本研究为大肠癌手术治疗和理论研究提供参考。     

新式剖宫产术的临床意义

目的 论证新式剖宫产术的临床意义。方法 对９９例行剖宫产术患者,采用钝性分离皮下组织,纵向撕开腹膜,Ｄｅｘｏｎ线连续锁扣缝合子宫全层,不缝合腹膜及腹直肌。Ｄｅｘｏｎ线连续缝合筋膜及间断全层缝合皮肤及皮下组织,并用这种剖宫产术与前期腹膜外剖宫产术比较。结果 新式剖宫产术时间短,手术损伤小,术中出血少,手术效果好,术后开奶早,切口疼痛轻,下床活动早,术后血尿率低等,与对照组比较有显著性差异（Ｐ〈０．０     

The radiological and urodynamic significance of large bladder diverticula

Large acquired bladder diverticula in adults may cause severe urodynamic disturbance and exacerbate difficulty in micturition. They may accommodate a large proportion of the contents of the bladder during attempted voiding, thus decreasing the effect of the detrusor muscle contraction. The post-micturition radiographs on intravenous urography, after the diverticula have emptied again, may only show a large intravesical post-micturition residue and give little information as to the size of the diverticula during the act of micturition.     

The clinical significance of small subarachnoid hemorrhages

With advancing technology, the sensitivity of computed tomography (CT) for the detection of traumatic subarachnoid hemorrhage (tSAH) continues to improve. Increased resolution has allowed for the detection of hemorrhage that is limited to one or two images of the CT exam. At our institution, all patients with a SAH require intensive care unit (ICU) admission, regardless of size. It was our hypothesis that patients with small subarachnoid hemorrhage experience favorable outcomes, and may not require the intensive monitoring offered in the ICU. This retrospective study evaluated 62 patients between 2011 and 2014 who presented to our Level I trauma center emergency room for acute traumatic injuries, and found to have subarachnoid hemorrhages on CT examination. The grade of subarachnoid hemorrhage was determined using previously utilized scoring systems, such as the Fisher, Modified Fisher, and Claassen grading systems. Electronic medical records were used to evaluate for medical decline, neurological decline, neurosurgical intervention, and overall hospital course. Admitting co-morbidities were noted, as were the presence of patient intoxication and use of anticoagulants. Patient outcomes were based on discharge summaries upon which the neurological status of the patient was assessed. Each patient was given a score based on the Glasgow outcome scale. The clinical and imaging profile of 62 patients with traumatic SAH were studied. Of the 62 patients, 0 % underwent neurosurgical intervention, 6.5 % had calvarial fractures, 25.8 % had additional intracranial hemorrhages, 27.4 % of the patients had significant co-morbidities, and 1.6 % of the patients expired. Patients with low-grade tSAH spent less time in the ICU, demonstrated neurological and medical stability during hospitalization. None of the patients with low-grade SAH experienced seizure during their admission. In our study, patients with low-grade tSAH demonstrated favorable clinical outcomes. This suggests that patients may not require as aggressive monitoring as is currently provided for those with tSAH.     

The clinical significance of acute pancreatic hemorrhage

Computed tomography (CT) has the ability to demonstrate acute hemorrhage both within the pancreatic parenchyma and the adjacent retroperitoneal spaces. It was found that during the acute phase of pancreatic hemorrhage (about 1-7 days) the CT number of hemorrhage is significantly greater than that of the gland. At the present time the true incidence of pancreatic hemorrhage and the relation of the CT demonstration of hemorrhage to the clinical entity of hemorrhagic pancreatitis is unclear. The CT, laboratory, and clinical findings in eight patients with acute pancreatitis were analyzed to help answer these questions. This limited experience suggests pancreatic hemorrhage is more frequent than hemorrhagic pancreatitis as currently defined clinically.     

The clinical significance of increased echogenicity in the fetal abdomen

Seven cases of increased echogenicity in the fetal abdomen detected on prenatal sonography were reviewed for findings and causes. In four cases, the findings corresponded to calcification secondary to meconium peritonitis, infection, or unknown cause. One infant with meconium ileus had inspissated but noncalcified meconium corresponding to the increased echoes. In two cases, follow-up prenatal sonography was normal, and the neonate was also normal. Eight cases from the literature with increased echogenicity in the fetal abdomen were also reviewed: Two cases were secondary to meconium ileus, and six were caused by meconium peritonitis. Increased abdominal echogenicity on prenatal sonography may result from various processes that may affect obstetric and neonatal management.     

The legal significance of clinical guidelines in The Netherlands

In The Netherlands the use of clinical guidelines has increased rapidly. To a growing extent, judges also refer to them. Although they are not regarded as legal rules, clinical guidelines do play various roles in judicial decision making. In attaching importance to clinical guidelines, judges sometimes speak about the qualities they look for. Scientific credibility, the prestige of the developing organisation, the way they come about, positiveness, clarity, carefulness and cognizability are mentioned. However, the importance attached to clinical guidelines by the courts does not endanger clinical autonomy. Except for one very instructive incident, Dutch judges have shown respect for clinical autonomy.     

18F-FDG uptake in reactive neck lymph nodes of oral cancer: relationship to lymphoid follicles

PET using (18)F-FDG is acceptable as a preoperative diagnostic tool for head and neck cancer. PET combined with CT provides precise localization of neck lymph nodes. Reactive lymphadenopathy is well known as a principal cause of false-positive findings on PET/CT for nodal staging. We investigated the reactive lymph nodes of oral cancer to elucidate the (18)F-FDG-avid area in these nodes. METHODS: Surgically dissected neck lymph nodes of oral cancer were retrospectively reviewed. Of the patients without pathologic nodal metastasis who underwent preoperative PET/CT, 11 patients with 31 enlarged lymph nodes at 20 levels were enrolled. The maximum standardized uptake value (SUVmax) of each lymph node was recorded. The diameters of the long and short axes were measured by pathologic sectioning, and the sectional surface area was calculated in square millimeters. Besides being stained with hematoxylin and eosin, the sections were immunohistochemically stained by CD79a for B cells, CD3 for T cells, CD68 for macrophages, CD21 for follicular dendritic cells (FDCs), and ubiquitous glucose transporter type 1 (GLUT1). The expression of GLUT1 was compared with staining of lymphoid cells. The numbers of total lymphoid follicles and hyperplastic secondary follicles were counted on CD21 and hematoxylin and eosin sections, respectively. The follicular reactivity index was determined as the ratio of secondary follicles relative to total follicles on the corresponding section. These parameters of reactive lymph nodes were analyzed on a level basis. RESULTS: GLUT1 was expressed exclusively in lymphoid follicles, whose staining pattern was identical to that of FDCs. The calculated sectional area correlated significantly with the number of total follicles (r = 0.560; P = 0.0101). SUVmax did not correlate with the number of total follicles (P = 0.8947) but correlated significantly with the number of secondary follicles (r = 0.535; P = 0.0152). In addition, a strong positive correlation between SUVmax and the follicular reactivity index was demonstrated (r = 0.829; P < 0.0001). CONCLUSION: GLUT1 was expressed on cytoplasmic protrusions of FDCs in lymphoid follicles. The (18)F-FDG accumulation in reactive lymphadenopathy depended on secondary follicles. FDCs in germinal centers of secondary follicles are suggested to be avid for (18)F-FDG and the principal cause of false-positive findings for nodal staging.     

The true clinical significance of renography in nephro-urology

Isotopic renography is a non-invasive technique used routinely by the clinician to provide information about kidney structure and function. Whilst there is no doubt of its value in the accurate measurement of glomerular filtration rate and in the detection of parenchymal abnormalities, its role in the diagnosis of renovascular disease (especially in patients with renal insufficiency), the exclusion of obstruction and the evaluation of the patient with either acute renal failure or renal transplant dysfunction remains unproven. In part, this reflects a failure to standardise protocols and rigorously evaluate diagnostic techniques. Recent developments in ultrasound, computerised X-ray tomography and nuclear magnetic resonance now present the clinician with rival techniques and emphasise the need for the clinical development of isotopic renography.     

视神经管骨折HRCT检查的临床意义

目的：探讨HRCT检查对视神经管骨折的临床意义。方法：对外伤性视神经伤患者12例行视神经管HRCT扫描,骨算法重建,对骨折的CT表现进行分析。结果：12例患者共14只眼视神经管骨折,视神经管内壁骨折8例,其中内壁为蝶窦壁6例、筛窦壁2例。外壁骨折3例,视柱骨折1便,上壁骨折3例,下壁骨折5例。视神经管骨折CT表现可分为4型：（1）线形型骨折;（2）凹陷型骨折;（3）粉碎型骨折;（4）混合型骨折。14只眼视神经管骨折中9只眼视神经管骨折是颅底骨折的一部分。结论：HRCT检查可提高视神经管骨折的诊断水平,为临床选择治疗方案提供影像依据,具有重要临床意义。