肾上腺外嗜铬细胞瘤25例临床分析

目的 分析肾上腺外嗜铬细胞瘤的发病情况，病理特征及诊断方法，探讨治疗措施。方法 通过对81例经手术与病理证实的嗜铬细胞瘤进行回顾性分析。结果 81例嗜铬细胞瘤患者中，经手术与病理证实的肾上腺外嗜铬细胞瘤25例，占同期收治嗜铬细胞瘤的30．9％。病人的临床表现除特殊部位肿瘤外与肾上腺髓质嗜铬细胞瘤相似。结论 肾上腺外嗜铬细胞瘤临床表现与生化诊断与肾上腺髓质嗜铬细胞瘤相似，其恶性者较肾上腺髓质嗜铬细胞瘤明显增多，定位诊断以^131I-MIBG为特异，治疗以手术最佳。     

SPECT/CT ^131I-MIBG显像在嗜铬细胞瘤诊断中的应用

目的观察SPECT/CT碘化间碘苄胍（^131I-MIBG）显像诊断嗜铬细胞瘤的效果。方法临床拟诊嗜铬细胞瘤的患者26例,均行^131I-MIBG全身显像,常规肾上腺区SPECT/CT图像融合断层,并对肾上腺外异常放射性浓聚区图像融合断层。结果 12例最终排除嗜铬细胞瘤者,SPECT/CT ^131I-MIBG显像为阴性;14例手术或活检组织病理检查证实为嗜铬细胞瘤者,SPECT/CT ^131I-MIBG显像为阳性。结论 SPECT/CT ^131I-MIBG显像能够定性并准确定位嗜铬细胞瘤（包括异位或转移性嗜铬细胞瘤）。     

后腹腔镜手术治疗嗜铬细胞瘤46例临床观察

采用后腹腔镜手术治疗肾上腺嗜铬细胞瘤45例（双侧2例）,腹主动脉旁嗜铬细胞瘤1例。结果46例患者行后腹腔镜手术48次,47次取得成功,1例因术中出血改行开放手术。认为后腹腔镜手术切除嗜铬细胞瘤安全有效,应成为医师首选方法。     

腔静脉血浆儿茶酚胺对嗜铬细胞瘤的定位

腔静脉血浆儿茶酚胺对嗜铬细胞瘤的定位金律，刘力生，王蕾礼，郑德裕应用高效液相色谱电化学检测法（ＨＰＬＣ－ＥＣ）测定腔静脉血浆儿茶酚胺（ＣＡ）对嗜铬细胞瘤定位，并探索此法对肿瘤定位的标准。一、对象和方法：经手术、病理与肿瘤ＣＡ检查证实的嗜铬细胞瘤患者９...     

以少见表现为首发症状的9例嗜铬细胞瘤临床分析

目的：探讨以少见表现为首发症状的的嗜铬细胞瘤的临床特点.方法：回顾性分析经手术病理证实为嗜铬细胞瘤并具有特殊临床表现的9例患者的临床资料结果：2例患者术前诊断为急性冠脉综合征;2例患者术前诊断休克;1例患者术前诊断为糖尿病酮症酸中毒;4例患者术前诊断为视神经炎.所有患者均有高血压.影像学检查均发现肾上腺占位病变,均经手术病理证实为肾上腺嗜铬细胞瘤,术后症状好转.结论：嗜铬细胞瘤表现多样化,高血压是重要的诊断线索,实验室及影像学检查对明确诊断有重要意义.     

异位嗜铬细胞瘤

目的了解异位嗜铬细胞瘤患者的临床特点,探讨诊断和治疗方法。方法回顾性分析12例异位嗜铬细胞瘤患者的临床表现、定位和定性检查以及治疗效果的资料。结果11例患者表现为持续性高血压,伴阵发性加重。11例测定了血儿茶酚胺,2例同时测定了24h尿儿茶酚胺。6例进行了腔静脉分段取血。8例患者手术治愈,4例患者药物控制良好。结论异位嗜铬细胞瘤以持续性高血压伴阵发性加重表现为主。血儿茶酚胺检查有助于病例诊断。无禁忌症患者应手术治疗。     

嗜铬细胞瘤23例临床特征分析

目的通过总结嗜铬细胞瘤的临床表现,提高该病的诊治水平。方法回顾性分析23例嗜铬细胞瘤患者的临床表现、生化检查、影像学检查及辅助检查。结果 23例病例的主要临床表现为高血压伴头痛、心悸,其中阵发性高血压18例,占78.3%;持续性高血压5例,占21.7%。24小时尿儿茶酚胺均高于正常值。追踪观察手术治疗效果,疗效明显。结论对有高血压并伴有头痛、心悸的患者,应考虑嗜铬细胞瘤的诊断,以减少漏诊误诊。     

异位嗜铬细胞瘤

目的了解异位嗜铬细胞瘤患者的临床特点,探讨诊断和治疗方法.方法回顾性分析12例异位嗜铬细胞瘤患者的临床表现、定位和定性检查以及治疗效果的资料.结果 11例患者表现为持续性高血压,伴阵发性加重.11例测定了血儿茶酚胺,2例同时测定了24 h尿儿茶酚胺.6例进行了腔静脉分段取血.8例患者手术治愈,4例患者药物控制良好.结论异位嗜铬细胞瘤以持续性高血压伴阵发性加重表现为主.血儿茶酚胺检查有助于病例诊断.无禁忌症患者应手术治疗.     

嗜铬细胞瘤20例临床分析

目的：探讨嗜铬细胞瘤临床特点，提高诊治水平。方法：对20例嗜铬细胞瘤的临床资料总结分析。结果：20例均经手术治疗，单侧17例，家族性双侧3例，恶性嗜铬细胞瘤4例，肾上腺外嗜铬细胞瘤1例，无症状嗜铬细胞瘤4例。结论：嗜铬细胞瘤典型表现是高血压、头痛、心悸和出汗，而无症状性、家族性和其他非典型的特殊表现需引起注意。儿茶酚胺及影像学检查是主要的诊断手段。     

经腹腹腔镜肾上腺嗜铬细胞瘤切除术(附15例报告)

目的观察经腹腹腔镜肾上腺嗜铬细胞瘤切除术治疗肾上腺嗜铬细胞瘤的疗效。方法用经腹腹腔镜手术治疗肾上腺嗜铬细胞瘤15例。结果手术均成功。手术时间50-160 min,术中出血量40-220 ml。12例随访5-36个月,10例患者血压恢复正常,2例血压明显下降,均无局部复发。结论经腹腔腹腔镜肾上腺嗜铬细胞瘤切除术术中解剖标志清楚,手术安全性高,效果满意,可作为肾上腺嗜铬细胞瘤首选治疗方法。     

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。     

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。     

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。     

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.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.