左半结直肠癌临床与病理学特点及诊治分析

目的　探讨左半结直肠癌 (LCRC)临床病理特点及诊治对策。方法　采用直接结肠镜检查加病理活检的方法确诊LCRC 85例 ,其中 37例经手术治疗。结果　本组 50岁以上占 60 %。农民占 73 %。首发症状至确诊 <3个月占 56 .5 % ,<1年占 89.4%。便血、腹痛腹胀、排便习惯改变、肛门异常是LCRC常见症状 ,便血为主要表现占 83 .5 % ,始发便血 56例 ,占 56/ 71 (76 .87% )。本组临床误诊率 63 .5 %。活检符合率 88.57%。病理形态以隆起 (肿块型 85 .88% )管状腺癌 (98.36 % )为主。 37例手术DUKES分期DaDb1 7例为可切除可治愈癌 ,占 45 .95 %。病程 <3个月DaDb 47.4% ,DcDd 52 .6 %。手术率乙状结肠以上癌 2 0 / 2 6(76 .92 % ) ,肛直肠癌 1 7/59(2 8.81 % )。结论　 >50岁属LCRC高发人群 ,为重点结肠镜检查对象。便血是LCRC始发主要表现和重要的结肠镜检查指征 ,应提高对便血的认识 ,放宽镜检范围。LCRC一经诊 ,应及早手术 ,这是切除或治愈LCRC的重要手段。     

鼻咽结核15例临床分析

目的：为提高鼻咽结核的临床诊断率。方法：对15例鼻咽结核进行回顾性分析，总结其临床特征，仅3例有肺结核史(20．0％)，8例以颈部包块为首发临床表现(53．3％)，11例初发时误诊为鼻咽部恶性肿瘤(73．3％)。结果：全部病例经正规抗结核药物治疗后痊愈，经6个月至2年随诊无复发。结论：鼻咽结核与鼻咽癌极易误诊，颈淋巴结肿大时要注意排除鼻咽结核并于鼻咽部恶性肿瘤相鉴别；鼻咽结核行全身抗痨治疗，同时应用5％链霉素局部灌洗，可显著提高疗效，缩短病程。     

Hepatic epithelioid haemangioendothelioma: difficult name,difficult diagnosis?

Two patients with epithelioid haemangioendotheliomata of the liver are described. Both presented with abdominal pain and malaise, with hepatomegaly and a variable degree of hepatocellular dysfunction. Diagnosis was delayed in both cases, each patient undergoing a protracted series of investigations including repeated liver biopsies. The major obstacles to early diagnosis were a lack of clinical awareness of the condition and difficulties in interpretation of the liver histology: the widespread sclerosis in the tumour tissue is easily mistaken for a post-necrotic or cirrhotic process. The key to the diagnosis is the demonstration of cells containing Factor-VIII-related antigen confirming the endothelial origin of the tumour. One patient died within three months of presentation and the other after 18 months. The tumour may, therefore, be more aggressive than earlier reports seem to suggest. It seems likely that the tumour is being under-diagnosed and although no specific therapy has been shown to be of value, a greater awareness of the condition, resulting in a more prompt diagnosis, should save patients from undergoing unnecessary investigation.     

The incidence of malignant mesothelioma in Australia, 1947-1980

Details of patients with malignant mesothelioma that was diagnosed in Australia before 1981 were obtained by searching all possible sources throughout Australia as far into the past as possible and up to and including 1980. The earliest patient with mesothelioma who was identified was diagnosed in Victoria in 1947. By 1980, 535 (81%) men and 123 (19%) women had been diagnosed with the disease; only 14 persons were aged less than 35 years at the time of diagnosis (the youngest person was 15 years of age). The incidence rate in subjects who were 35 years or older at diagnosis was less than 1.0 cases per million person-years until 1964-1968, and then it rose progressively to 15.5 cases per million person-years in 1979-1980. The highest rate (69.7 cases per million person-years) was observed in 65- to 74-year-old men in 1979-1980. The incidence rate in Western Australia was greater than were the rates in other states of Australia after the mid 1960s. Pleural mesotheliomas accounted for 88% of cases in which the site of the tumour was known; peritoneal mesotheliomas accounted for 10% of such cases and "other" sites for 2% of such cases. In 6% of cases the site was not specified. The exposure to asbestos was stated as "definite" in 59% of the cases with a recorded history of exposure: 8% of all the cases in the study had been exposed to crocidolite (blue asbestos) from Wittenoom Gorge in Western Australia. The age at diagnosis of patients with known exposure to asbestos was similar to that in those without known exposure. The increases in the incidence of malignant mesothelioma in Australia follow the published trends in the production and use of the amphibole varieties of asbestos in this country after a lag period of between 20 and 30 years.     

Multiple primary malignancies involving lung: an analysis of 40 cases

We aimed to assess the incidence of multiple primary malignancies in primary lung cancer patients. We retrospectively evaluated the clinical files of 1038 primary lung cancer patients diagnosed in 2004. Forty patients (3.9 %) had multiple primary malignancies. There were 34 men (85 %) and 6 women (15 %). Their mean age was 62.4 +/- 8.6 years. While 35 cases were smokers, 5 cases were nonsmokers. Tumour pathology of the lung was squamous cell carcinoma in 15 cases, adenocarcinoma in 10 cases, small cell carcinoma in 3 cases and non-small cell carcinoma in 12 cases. There were 2 primary tumours in 37 cases and 3 primary tumours in 3 cases. The first detected tumour was located in larynx in 11 cases, in genitourinary system in 9 cases, in intestine in 5 cases, in lung in 3 cases and in other organs in 12 cases. The mean interval between the first and the second tumour was 77 months with a range of 1 months to 32 years. This interval was shorter than 6 months in 4 cases. Treatment modality for the first detected tumour was surgery in 35 cases. The last primary tumour was treated with surgery in 12 cases. In conclusion, the development of multiple primary tumours is not a rare phenomenon. Patients with a malignancy should be followed for development of a second primary malignancy. The treatment of lung cancer in patients with a previous malignancy should be the same as for lung cancers presenting as the first cancer.     

Infiltrating ductal carcinoma of the breast in South Australia. Implications of trends in tumour diameter, nodal status and case-survival rates for cancer control

The SA Central Cancer Registry gained sufficient information from routine pathology reports to record both the diameter and the nodal status for approximately half the infiltrating ductal carcinomas of the breast that were diagnosed in that State between 1980 and 1986. Of these, 27% of cancers had diameters of less than 2.0 cm at diagnosis and a similar proportion measured 4.0 cm or more. Almost half (48% of cancers) showed evidence of axillary nodal metastasis. Although the over-all variation in diameters by socioeconomic status did not approach statistical significance, lesions tended to be smaller in cases from the upper than the middle or lower socioeconomic areas of Adelaide. There also was evidence of earlier diagnosis during a breast self-examination campaign, but only a marginal increase in case-survival rates that readily was attributable to chance. A relatively poor case-survival rate applied in non-metropolitan areas, especially among older women, after adjusting for the available information on the stage of disease at diagnosis. A more limited access to treatment services may have been responsible. It will be important in a State-wide mammographic screening programme to provide for ready access by women in non-metropolitan areas to both screening and follow-up treatment services.     

Medulloblastoma

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纤维支气管镜在小儿肺炎诊治中的临床应用

目的探讨纤维支气管镜（纤支镜）在小儿肺炎诊治中的临床应用价值。方法回顾性分析2011年8月至2013年5月郑州大学第三附属医院呼吸科在局部浸润麻醉下行纤支镜诊治136例小儿肺炎的临床资料。结果136例患儿平均发病年龄为4．5岁,1—6个月42例,6个月～1岁26例,1～3岁36例,3～7岁24例．7～14岁8例。其中肺部感染109例（80．1％）,先天性支气管肺发育异常14例（10．2％）,支气管异物7例（5．1％）。灌洗液细菌培养阳性37例（27％）,痰培养阳性31例（23％）,灌洗液培养阳性率略高于痰培养。117例患儿经纤支镜灌洗后症状迅速改善,治愈率为86．0％。7例气管异物经纤支镜做出明确诊断。结论局部浸润麻醉下纤维支气管镜术方法简单,安全有效,为小儿肺炎的病因诊断及治疗提供了安全有效的方法。     

Risk of cancer in children with AIDS. AIDS-Cancer Match Registry Study Group

CONTEXT: Population-based data on cancers associated with acquired immunodeficiency syndrome (AIDS) in children are lacking. OBJECTIVE: To determine risk of pediatric AIDS-associated cancers. DESIGN, SETTING, AND PARTICIPANTS: Using records from 11 locations in the United States for varying periods between 1978 and 1996, we linked data for children aged 14 years and younger at AIDS diagnosis to local cancer registry data. MAIN OUTCOME MEASURES: Cancer frequency and, in the 2-year post-AIDS onset period, cancer incidence and relative risk (RR; measured as standardized incidence ratio), by cancer type. RESULTS: Among 4954 children with AIDS, 124 (2.5%) were identified as having cancer before, at, or after AIDS onset, including 100 cases of non-Hodgkin lymphoma (NHL), 8 of Kaposi sarcoma (KS), 4 of leiomyosarcoma, and 2 of Hodgkin disease; there were 10 other or unspecified cancers. Expected numbers for all cancers identified in the study sample, based on population rates (using area-specific registry data), were less than 1. In the first 2 years after AIDS diagnosis (5485 person-years), NHL incidence was 510 per 100,000 person-years (RR, 651; 95% confidence interval [CI], 432-941). Median time for developing NHL after AIDS diagnosis was 14 months (range, 3-107 months). The most common type of NHL was Burkitt lymphoma. However, the risk of primary brain lymphoma (91 per 100,000 person-years) was especially high (RR, 7143; 95% CI, 2321-16,692), and 4 cases were diagnosed more than 2 years (range, 37-98 months) after AIDS onset. Leiomyosarcomas also tended to occur several years after AIDS onset, with 3 of the 4 cases occurring 33 to 76 months after AIDS diagnosis, whereas KS was reported only at or within 2 years of AIDS diagnosis. Hodgkin disease risk was also significantly increased (RR, 62; 95% CI, 2-342). CONCLUSIONS: The spectrum of AIDS-associated pediatric cancers resembled that seen in adults, with the addition of leiomyosarcoma. Both primary brain lymphomas and leiomyosarcomas tended to occur in children surviving several years after AIDS onset. Because the expected numbers of these cancers in this population were less than 1 and because of the small numbers of some types of observed cancers, the RR estimates are imprecise and caution is warranted in their interpretation. JAMA. 2000;284:205-209     

肺大细胞神经内分泌癌的手术治疗（附16例报告）

 目的分析肺大细胞神经内分泌癌（LCNEC）的临床特征、治疗及生存情况。方法回顾性分析16例LCNEC患者的临床资料,并随访治疗效果及预后。结果无一例术前确诊;术后病理免疫组化分析符合LCNEC特点;术后病理分期为：ⅠA期患者1例,ⅠB期2例,ⅡA期5例,ⅢA期6例,ⅢB期2例。术后5例患者接受含铂类药物辅助化疗;全组术后随访5～38个月,平均17个月;9例患者术后数月内发生肿瘤复发或转移,平均无病生存期为7.5个月;13例患者生存超过１年（81.25％）,其中1例无病生存13个月;3例患者生存超过2年（18.75％）,分别为25,29,38个月,均为无病生存。 结论肺LCNEC为高度侵袭性肿瘤,易复发和转移,预后差,手术结合术后含铂类辅助化疗可能延长患者的生存时间。     

安徽省2016—2019年输入性疟疾病例就诊和诊断情况分析

目的 分析安徽省输入性疟疾病例就诊和诊断情况,为制定消除疟疾后阶段阻断输入性疟疾再传播技术措施提供依据。方法 收集全国传染病报告信息管理系统和寄生虫病防治信息管理系统中2016—2019年安徽省报告的输入性疟疾病例就诊和诊断资料,对就诊和诊断机构、诊断及时性等情况进行描述性分析。结果 2016—2019年安徽省共报告输入性疟疾421例,四种虫种均有,死亡3例。86.5%（364/421）的病例初诊单位在医疗机构,70.1%（295/421）的病例初诊即被正确诊断为疟疾,疾控机构初诊正确率（100.0%）高于医疗机构（66.8%）,差异有统计学意义（P<0.05）;级别越高的医疗机构初诊正确率越高（P<0.05）。由医疗机构确诊的病例占总病例数的83.4%（351/421）。2016—2019年,确诊病例的医疗机构级别总体呈下降趋势,疾控机构所占构成比也呈下降趋势（P<0.05）。5.9%的病例在发病的当天被确诊,49.6%的病例在发病后1~3 d内被确诊。各年份发病-初诊时间间隔天数构成比差异无统计学意义（P>0.05）;各年份初诊-确诊时间间隔天数构成比差异有统计学意义（P<0.05）,2019年初诊当天确诊率高于其他年份;医疗机构和疾控机构的当天确诊率均呈上升趋势,各年份医疗机构的初诊当天确诊率均低于疾控机构（P<0.05）。恶性疟就诊后和发病后0~3 d确诊率分别为86.4%和60.3%,高于其他虫种感染。轻症和重症恶性疟病例的发病-初诊时间差异无统计学意义（P>0.05）,重症和轻症恶性疟病例初诊-确诊时间中位数（P₂₅,P₇₅）分别为3（1,5） d和1（1,3） d,差异有统计学意义（P<0.05）。3例死亡病例在初诊时未被确诊,于发病后≥3 d确诊。结论 安徽省输入性病例的初诊和确诊单位主要在医疗机构,尤其是县级以上医疗机构,需继续提高医疗机构的疟疾诊断水平,并减少重症病例的发生,同时加强健康教育以提高病例及时就诊意识。     

原发性胃恶性淋巴瘤16例胃镜下特征及临床特点分析

目的探讨原发性胃恶性淋巴瘤的临床特点及镜下特征,提高临床诊疗效果。方法回顾性分析2004年至2010年襄阳市第一人民医院收治的16例原发性胃恶性淋巴瘤患者胃镜下表现情况及临床资料。结果16例中I期4例,Ⅱ期5例,Ⅲ期5例,Ⅳ期2例。单纯手术治疗4例,单纯化疗2例,手术及术后化疗10例,采用CHOP方案5例,R—CHOP方案7例。1例死于术后并发症,15例出院,随访12～61个月．死亡5例,存活2年以上9例（56．3％）,5年及以上4例（25．0％）。结论原发性胃恶性淋巴瘤术前诊断困难,胃镜组织活检病理检查为最有效的诊断方法,个体化治疗方案有助于提高患者5年生存率,改善预后。     

原发性阑尾恶性肿瘤15例诊治分析

目的　探讨原发性阑尾恶性肿瘤早期诊断、早期治疗的方法和疗效。方法　回顾研究近 2 0年来接受治疗并经病理证实的阑尾恶性肿瘤 ,结合有关文献分别讨论了阑尾类癌、腺癌和粘液性囊腺癌的发病率、临床表现及诊治要点。结果　阑尾类癌 8例 ,腺癌 5例 ,粘液性囊腺癌 2例 ,均经手术治疗 ,除粘液性囊腺癌 2例一期回盲部切除 ,余病例均单纯阑尾切除。术前无 1例获正确诊断。根据病理结果 ,类癌直径 >1.5cm者行二期右半结肠切除 ,腺癌者行右半结肠切除加区域淋巴结清扫术。结论　阑尾肿瘤与阑尾炎关系密切 ,术中仔细探查与病理结果对正确的手术方式选择有重要作用     

1373例宫颈病变的临床病理分析

通过对１３７３例宫颈标本的肉眼形态、临床症状与病理诊断的对比分析，结果宫颈良性病变占７７．４％，其中呈糜烂及糜烂伴触血阳性者以糜烂较多见；宫颈光滑、肥大者以炎症为主。恶性病变占２２．６％，其中鳞癌占恶性肿瘤的９７．７％；年龄在５０岁以上，临床表现为绝经后出血，宫颈呈溃疡、肿块者浸润癌的可能性最大；年龄在３０～４９岁，宫颈呈糜烂或糜烂伴触血阳性，临床表现为接触性出血，血性白带或不规则出血者，原位癌多见。     

流行性出血热病毒单克隆抗体在临床早期诊断中应用的研究

用IFAT检测77例临床诊断为EHF病人的外周血白细胞中的病毒抗原。阳性率为50.6％。2—5病日的早期病人阳性率为64.3％(27/42)。并发现,病日越早,病情越重,阳性率越高。试验中应用了抗EHF病毒McAb4B_9、4E_7、3H_4株。抗原阳性者对3种McAb的反应表现为5种类型。不同McAb对抗原的检出率不同,混合使用McAb可提高阳性检出率。在EHF病毒抗原阳性早期患者中,急性期血清特异性IgM抗体阳性率为96.3％。若联合检测EHF病毒抗原和急性期血清IgM抗体,可提高早期诊断的阳性率和准确性。     

Changing face of adult coeliac disease: experience of a single university hospital in South Yorkshire

Objective: To determine the incidence and presenting features of adult coeliac disease in a single university hospital in South Yorkshire. Design: A retrospective case finding study. Data were obtained from pathology and immunology databases, clinical notes, dietetic records, and patient questionnaires. Setting: Royal Hallamshire Hospital in South Yorkshire, England. Participants: All recorded cases of coeliac disease. Main outcome measures: Crude annual incidence rates for coeliac disease was obtained. The numbers of coeliac antibody profiles requested per year from the Royal Hallamshire Hospital were ascertained. Age at diagnosis, sex, year of diagnosis, presenting symptoms, associated conditions, and delay in diagnosis was documented. In addition the specialty of the clinician who made the diagnosis was noted. Results: There were 264 cases in total (male n=86, ratio 1:2). Mean age at diagnosis was 44.9 years (range 1–82, median 44.5). A trend was observed from 1990 to 2000 inclusive, of an annual increase in the incidence of coeliac disease. There has been a coincidental increase in the measurement of associated antibodies. Although 28.4% of patients presented with gastrointestinal symptoms, 20.1% had iron deficiency anaemia. The ratio of typical to atypical symptoms was 1:2.5. (single sample test of proportions p<0.001). The diagnosis was made by a gastroenterologist in only 52.7% of cases. The median duration of symptoms before the diagnosis of coeliac disease was 4.9 years (range 0.25–16 years). Conclusion: Coeliac disease is now presenting more commonly without gastrointestinal symptoms and often to specialties other than gastroenterology. Although more cases are diagnosed, this may be a reflection of increasing recognition rather than a true increase in incidence.     

年轻妇女宫颈癌临床分析与早期诊断

目的 探讨年轻妇女宫颈癌的临床表现与早期诊断.方法 对1995～2005年我院收治的37例＜35岁年轻宫颈癌患者的临床分期、症状、体征进行回顾性分析,并以同期≥35岁宫颈癌106例做对照研究.结果 年轻妇女宫颈癌早期比例高于年长者,临床症状主要为接触性出血、白带异常,而年长者主要为不规则出血、接触性出血.结论 年轻妇女宫颈癌早期比例高,临床表现多样化,应定期筛查,提高其早期诊断率.     

宫腔镜诊治子宫粘连的临床疗效观察

目的探讨宫腔镜在诊断和治疗子宫粘连中的作用。方法回顾性分析2011年3月-2013年1月收治的42例宫腔粘连患者官腔镜诊治情况。结果术后4～6个月随访，42例宫颈官腔粘连患者中，39例在第1次官腔镜下分离完成，成功率928％。术后月经恢复正常34例（809％），月经偏少7例（167％），1例（24％）术后1年月经仍未恢复；官腔镜分离子宫粘连患者，就诊时间越早，治愈率越高。结论官腔镜诊治子宫粘连简单安全，准确可靠。     

肝胆管结石合并胆管癌漏诊及防治(附52例分析)

目的 探讨肝胆管结石与胆管癌的关系,总结该病的漏诊原因及防治经验.方法 回顾性分析1998年1月～2010年12月经病理证实的52例肝内胆管结石合并胆管癌的临床资料,并对其诊断、治疗和预后进行总结.结果 52例胆管癌的发生率占同期肝内胆管结石患者的4.17％(52/1248).其中,术前诊断者17例,术前诊断正确率32.7％( 17/52),术前漏诊率达67.3％(35/52).术前漏诊的35例中,26例经术中探查结合病理切片得到确诊,7例术中未发现但术后病理证实为胆管癌,其余2例为取石及肝叶切除术后数月病情恶化,再次手术得以证实.术前及术中诊断的患者有21例获得根治性切除,切除率为40.4％(21/52).肝胆管癌行根治切除者平均生存34.2个月(14～65)个月;仅作姑息性内或外引流者平均生存11.7个月(3～14个月);仅作剖腹探查者平均生存2个月(1～4个月).结论 肝内胆管结石合并胆管癌的早期诊断困难,漏诊率高.根治性切除较姑息性手术能显著提高患者的生存率和生存质量.重视该病,早期诊断、早期治疗,争取根治性切除能提高肝胆管结石合并胆管癌疗效.     

ASC -BPPV 的眼震电图定位模式及反式 CRP的临床应用

目的：探讨应用眼震电图检查前半规管良性位置性眩晕（ ASC-BPPV）眼震电图定位模式的合理性,评价在此诊断基础上采用反式Epley耳石复位法（ T-CRP）的疗效。方法收集8例诊断为ASC-BPPV患者的临床资料。其中右侧ASC-BPPV 6例,左侧ASC-BPPV 2例,病程1周～6月。所有病例均进行眼震电图定位模式定位后行反式CRP治疗,观察其临床疗效。结果8例ASC-BPPV的眼震表现均符合ASC-BPPV眼震电图定位模式,经反式CRP治疗后8例眩晕均得到不同程度缓解,总有效率达100％。5例达到痊愈效果,占62．5％,3例治疗有效,占37．5％。结论 ASC-BPPV的眼震电图定位模式符合临床客观资料,其与内耳解剖密切相关,临床上反式CRP是针对ASC-BPPV的一种有效治疗方案。