小儿睾丸卵黄囊瘤6例临床病理分析

目的 探讨小儿睾丸卵黄囊瘤的临床病理及预后，方法 对6例小儿睾刃卵黄囊瘤的临床病理特征、免疫组化以及随访情况进行分析。结果 瘤组织由多形性瘤细胞排列成网状结构、血管套样或腺样，瘤细胞质内外有透明小体。免疫组化显示瘤细胞AFP、AAT染色（ ）。结论 病理检查容易明确诊断，测定血清AFP水平对确定肿瘤性质、监控治疗效果有重要意义。     

心原发性卵黄囊瘤临床病理观察

目的分析心原发性卵黄囊瘤临床病理特征及诊断、鉴别诊断要点。方法对1例发生于心的肿瘤进行组织形态学观察和免疫组化研究,结合文献探讨其病理组织特征。结果镜下见肿瘤细胞呈立方、柱状,核深染,大小不一,有异型。瘤细胞形成微囊、乳头状结构,可见SD小体、透明小体及出血、坏死。免疫组化显示CK、PLAP、AFP和AAT(+),PAS亦(+)。结论心原发性卵黄囊瘤非常罕见,由于其临床表现无特异性,早期诊断困难,诊断主要依赖于组织形态学及免疫组化检查。     

伴有卵黄囊瘤成分的卵巢上皮性肿瘤临床病理特点分析

目的总结分析伴有卵黄囊瘤成分的卵巢上皮性肿瘤病例的临床病理特征及诊断与鉴别诊断要点。方法和结果按病理诊断定义总结本文2例(其中,1例为会诊病例)及文献病例共35例,其中本院2例年龄分别为58岁和61岁。盆腔B超均显示为一侧附件区的囊实性占位,最大径分别为13.5 cm和12 cm,其中实性区直径分别为6.1 cm和6 cm。术前血清AFP分别为219.7 ng/ml和19000 ng/ml。2例均进行全子宫及双附件切除手术。大体检查显示一侧卵巢被囊实性肿物取代,实性区呈灰黄、灰褐色,可见坏死。镜下2例肿瘤组织均由2种成分组成,伴出血和坏死,一种成分为明确的卵巢恶性上皮性肿瘤(1例为透明细胞癌,1例为子宫内膜样癌);另一种成分为卵黄囊瘤成分,前者卵黄囊瘤成分呈网状及乳头状结构,可见S-D小体,后者表现为实性及腺样结构。免疫组化2例中卵巢癌成分CK7和EMA均为(+),AFP和SALL4均(-);2例卵黄囊瘤成分CK7和EMA均(-),AFP和SALL4均(+)。2种成分呈移行和重叠并存。结论伴有卵黄囊瘤成分的卵巢上皮性肿瘤少见,以老年妇女为主,患者常有血AFP水平不同程度增高。其中上皮性成分多为恶性。形态学结合血清学AFP改变及免疫组化CK7、EMA、AFP和SALL4可以确定诊断。准确的病理诊断是术后针对性治疗的关键,Ⅱ期及以上病例预后较差。     

SALL4在原发性卵黄囊瘤诊断中的应用

目的评价SALL4在原发性卵黄囊瘤病理诊断中的应用价值。方法采用免疫组化EnV ision法检测SALL4蛋白在32例性腺及性腺外原发性卵黄囊瘤中的表达情况,其中睾丸14例,卵巢12例,骶尾部5例,脑1例。另外,选取10例卵巢粒层细胞瘤,5例卵巢透明细胞癌,正常睾丸及卵巢组织各10例作为对照。同时检测AFP和glypican-3在上述肿瘤中的表达情况。结果所有卵黄囊瘤均SALL4(+)(100%),均中度至强(+);28例glypican-3(+)(87.5%),其中24例(75%)中度至强(+),4例(12.5%)弱(+);25例(78.1%)AFP(+),其中22例(68.8%)弱至中度(+),3例(9.4%)强(+)。SALL4表达率和表达强度均高于AFP和glypican-3,差异显著(P0.05)。对照组中,卵巢粒层细胞瘤1例AFP和glypican-3灶性弱(+),SALL4(-)。卵巢透明细胞癌1例AFP灶性弱(+),SALL4和glypican-3(-)。正常睾丸及卵巢组织SALL4、AFP和glypican-3均(-)。结论SALL4是诊断卵黄囊瘤特异性较好的免疫标记物,其阳性率和阳性强度均优于AFP和glypican-3,特别有助于与卵巢粒层细胞瘤和透明细胞癌的鉴别。     

骶尾部卵黄囊瘤9例临床病理分析

目的探讨骶尾部卵黄囊瘤(YST)的临床病理学特征及诊断与鉴别诊断。方法对9例骶尾部卵黄囊瘤进行临床病理分析及免疫组化染色,同时复习相关文献。结果 8例为女童,1例为男童,发病年龄16个月~44个月。以臀部或骶尾部包块为主要临床表现。组织病理学检查均可见到典型的内胚窦结构以及腺样、乳头状和疏松网状结构。免疫组化显示9例AFP(+),其中5例呈灶状(+),4例胞质呈弥漫性强(+);2例PLAP灶状(+);8例CK呈强(+),1例(-);9例CD30、HCG、EMA、CD15和CD117均(-)。5例确诊后及时进行化疗,3例未化疗者短期内复发死亡,1例失访。结论骶尾部卵黄囊瘤多见于女婴,恶性度高,化疗敏感,诊断主要依靠组织形态与免疫组化染色。     

10例小儿睾丸卵黄囊瘤临床病理和免疫组化观察

目的探讨睾丸卵黄囊瘤的形态结构特点及免疫组化技术在该瘤的诊断及预后中的意义。方法10例睾丸卵黄囊瘤的存档蜡块,经切片、HE染色,分别以AFP、AAT、HCG、CEA、CK、Vimentin行免疫组化S-D法染色。结果HE染色以疏松网状结构、嗜酸性透明小体、S-D小体、腺体及腺样结构为最常见。免疫组化AAT10例均阳性,阳性范围和强度大于AFP。3例CEA阳性病例中,2例死亡,1例失访。HCG均阴性。Vimentin、CK均阳性。结论免疫组化检测该肿瘤的标记蛋白对诊断和预后的判断有一定价值。AAT可作为此瘤的特征性蛋白标记。CEA与肿瘤的预后可能有一定关系。     

性腺外恶性生殖细胞肿瘤37例临床病理分析

目的 探讨性腺外恶性生殖细胞肿瘤的病理类型和临床特点。方法 根据WHO肿瘤国际组织学分类(第2版)对37例性腺外恶性生殖细胞肿瘤重新评价，部分病例做相应免疫组化染色，并将肿瘤的组织类型和临床特点与性腺恶性生殖细胞肿瘤进行比较分析。结果 患者年龄1．5～58岁，中位年龄24岁。男性28人，女性9人，男女之比为3．1：1。发生于纵隔28例，腹膜后5例，前列腺、骶尾部、鞍区、阴道各1例。列前三位的肿瘤分别是卵黄囊瘤、畸胎瘤(未成熟畸胎瘤、PNET和畸胎瘤恶变)和精原细胞瘤，另有5例为混合型生殖细胞瘤。结论 性腺外恶性生殖细胞肿瘤相对少见，预后差，发病率与年龄、性别关系密切，好发部位为纵隔和腹膜后，卵黄囊瘤最为多见。     

胃原发性成人卵黄囊瘤临床病理学分析

目的分析胃原发性成人卵黄囊瘤临床病理学特征及诊断、鉴别诊断要点。方法对1例发生于胃的成人卵黄囊瘤进行组织形态学观察和免疫组化研究,结合文献探讨其病理组织特征。结果镜下见肿瘤细胞呈立方、柱状,核深染,大小不一,有异型。瘤细胞形成微囊、乳头状结构,可见SD小体、透明小体。免疫组化显示CK、CAM5.2、AFP(+)。结论胃原发性成人卵黄囊瘤非常罕见,由于其临床表现无特异性,早期诊断困难,诊断主要依赖于组织形态学及免疫组化检查。     

卵巢卵黄囊瘤1例报告

正卵黄囊瘤又称内胚窦瘤,是一种由胚外结构卵黄囊发生恶变的原发生殖细胞肿瘤~([1]),临床上罕见发生于儿童及年轻女性性腺,AFP升高是该肿瘤的特点,占卵巢恶性肿瘤1%,对育龄期女性影响较大,治疗过程中应尽可能保留生育功能,生长迅速,易早期转移,预后差,BEP辅助化疗方案可显著改     

伴生殖细胞肿瘤成分的子宫腺癌的临床病理研究

目的探讨伴有生殖细胞肿瘤成分的子宫腺癌的临床病理特点、治疗及预后。方法收集2例子宫腺癌伴生殖细胞肿瘤成分分化的病例,1例为高级别子宫内膜癌伴卵黄囊瘤分化,1例为宫颈腺癌复发后出现卵黄囊瘤及少许绒毛膜上皮癌分化。复习2例患者详细的临床资料,观察其组织学及免疫组化特点,并查阅相关文献进行分析总结。结果伴生殖细胞肿瘤分化的子宫腺癌,组织病理学上主要表现为明确的腺癌区及生殖细胞肿瘤分化区。腺癌区:肿瘤细胞呈典型的腺样或条索状生长;免疫组化显示肿瘤细胞CK、CK7、EMA、PAX8(+)。生殖细胞肿瘤分化区(卵黄囊瘤或绒毛膜上皮癌分化):肿瘤细胞呈微囊性、假腺样、实性巢片状生长,细胞异型性明显,部分区域可见S-D小体,肿瘤细胞周围可见出血、坏死;免疫组化显示肿瘤细胞AFP、SALL4、h CG、PLAP及OCT-4等(+)。该类疾病主要发生于绝经后妇女,临床表现为阴道异常出血,并常伴有血h CG和(或)AFP水平的升高。结论子宫腺癌伴发生殖细胞肿瘤分化可能属于一种去分化现象,在病理诊断上易漏诊、误诊。本病侵袭性强,预后差,临床多采取手术切除治疗,对放、化疗反应不敏感,多于术后2年内死亡。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.