乳腺叶状肿瘤的临床与影像诊断

乳腺叶状肿瘤(PTs)是由乳腺间质和上皮成分构成的纤维上皮型肿瘤,常需要与乳腺纤维腺瘤鉴别.乳腺叶状肿瘤临床手术切除后复发和转移率较高,因此首次术式选择非常重要,强调切除范围应足够大,术前影像学检查可为诊断提供必要的参考.从而提示临床选择恰当的手术方式.就PTs的临床病理特点和影像学表现进行综述.     

乳腺叶状肿瘤临床病理分析

目的:探讨乳腺叶状肿瘤(PTs)的临床病理学特点.方法:时6例乳腺叶状肿瘤患者的临床资料进行回顾性分析.结果:PTs大体上均表现为界限清楚的肿块,且呈分叶状.肿瘤由具有双层排列的上皮成分以及过度生长的间质成分组成.根据间质的过度生长程度、细胞的异型程度、核分裂数、有无异源性成分以及肿瘤性坏死等继发性改变将其分为良性、交界性和恶性3个级别.结论:乳腺叶状肿瘤发病率低.术前诊断困难,其诊断主要依据组织学观察.     

MRI在乳腺叶状肿瘤与纤维腺瘤鉴别诊断中的价值

目的 分析乳腺叶状肿瘤(PTs)的MRI特征,提高PTs与纤维腺瘤(FAs)的鉴别诊断水平.方法 搜集经手术病理证实、行MRI检查的PTs患者10例及FAs患者33例,分析其MRI表现,并进行统计学分析,比较两者的差异.结果 10例PTs中,术后病理诊断良性2例,交界性8例.叶状肿瘤具有短期内明显增大病史,在最大横径、深分叶、T1WI上存在高信号区域、T2囊性成分、低信号的分隔、不均匀强化、增多的血管、时间-信号强度曲线上,与FAs有统计学差异(P =0.026).在T2WI信号、胆碱(Cho)峰值上,两者没有统计学差异.结论 PTs和FAs在MRI表现上有一定差异,有助于PTs的正确诊断.     

乳腺叶状肿瘤9例临床病理分析

乳腺叶状肿瘤旧称叶状囊肉瘤，是一种呈分叶状结构、由乳腺纤维结缔组织和上皮成分组成的少见的纤维上皮性肿瘤，约占所有乳腺肿瘤的0．3％-0．5％。乳腺叶状肿瘤的生物学行为较难预测，其组织学分类也是一个难题。本文收集1988—2002年9例，现报告如下。     

乳腺叶状肿瘤的X线表现及病理对照分析

目的 分析乳腺叶状肿瘤(phyllodes tumors of the breast, PTs)的X线特征,并与病理结果相对照.方法 回顾性分析60例经手术病理证实PTs的X线特征及病理表现.良性PTs 5例,交界性PTs 45例,恶性PTs 10例,其中1例含有软骨肉瘤成分,1例含有脂肪肉瘤成分,其余PTs含有纤维肉瘤成分.结果 (1)60例PTs,53例X线片表现为肿块,7例为肿块伴钙化,包括交界性PTs 4例,恶性PTs 3例.46例有"透亮晕征".(2)肿物圆形6例,卵圆形14例,分叶形35例(其中14例表现为深分叶或多结节样堆积或肿块周围伴发结节),不规则形5例.26例肿块边缘清楚光滑,28例边缘模糊,6例边缘呈浸润性改变. 结论良性PTs常为边缘清楚的分叶状肿块,边缘浸润的分叶状肿块常为恶性.     

乳腺叶状肿瘤的影像学表现与病理对照分析

目的 探讨不同病理学分级的乳腺叶状肿瘤(PTs)的影像学表现,提高对PTs的认识及诊断水平.方法 回顾性分析65例经手术病理证实为PTs患者的临床及影像学资料,其中61例行超声和MRI检查,44例行X线检查,并与其病理学结果相对照.结果 (1)65例PTs患者,病理类型为良性、交界性和恶性的百分比分别为32.3%(21/65)、43.1%(28/65)和24.6%(16/65);其病灶的平均最大径分别为(4.75±2.62) cm、(5.37±3.11) cm和(4.96±3.82) cm,差异无统计学意义(F=0.247,P=0.782).(2)在44例PTs患者(包括良性16例,交界性18例,恶性10例)的X线图像上,病灶透亮晕及钙化有无在三者中差异有统计学意义(P均<0.05).(3)在61例PTs患者(包括良性19例,交界性26例,恶性16例)的声像图上,不同病理类型病灶形状差异有统计学意义(P<0.05).(4)在61例PTs患者(包括良性21例,交界性24例,恶性16例)的MRI图像上,三者在T2WI上病变内低信号分隔的有无、时间-信号强度曲线(TIC)方面差异有统计学意义(P均<0.05).结论 乳腺PTs的影像学表现有助于明确其病理学分类.     

乳腺叶状肿瘤MRI表现特征分析

目的分析乳腺叶状肿瘤(phyllodes tumors,PTs)MRI平扫、动态增强、扩散加权成像(DWI)和磁共振波谱(MRS)表现特征,提高对本病MRI诊断水平。资料与方法搜集2005年1月至2008年12月期间于我院行乳腺MRI检查并经手术病理证实的5例乳腺PTs,按照美国放射学会提出的乳腺影像报告和数据系统磁共振成像(BI-RADS-MRI)标准,回顾性分析病变的MRI表现,包括形态学、平扫T1WI及T2WI信号、动态增强表现及强化曲线类型、DWI信号及表观扩散系数(ADC)值和MRS表现特征。结果5例乳腺PTs病理诊断良性1例,交界性2例,恶性2例。MRI上4例表现为分叶状,1例为卵圆形;5例PTsMRI平扫T1WI均呈较低信号,T2WI呈高信号,其中1例内有低信号分隔;4例行动态增强检查的PTs于动态增强早中期(增强后第一至第三时相)呈快速渐进性强化,动态增强中后期时间-信号强度曲线3例呈平台型,1例呈轻度流出型;5例PTs于DWI上均呈高信号,ADC值低于正常乳腺组织,且低于鉴别乳腺良恶性病变的ADC界值;3例行MRS检查,均可见胆碱(Cho)峰。结论MRI检查有助于乳腺PTs的诊断,但确诊仍需...     

乳腺叶状肿瘤的MRI表现及临床病理学分析

目的:分析乳腺叶状肿瘤(phyllodes tumors,PTs)的MRI表现,以提高MRI的诊断价值。方法:回顾性分析8例PTs患者的临床及影像资料,包括肿瘤在T1WI、STIR序列上的信号强度,肿瘤大小、形状、边缘、内部强化方式、早期强化率、时间-信号强度曲线(time-signal intensity curve,TIC)类型及ADC值;比较PTs与正常腺体ADC值的差异。结果:8例乳腺PTs中,3例良性,4例交界性,1例恶性。MRI平扫T1WI呈等及较低信号,STIR呈高信号,3例肿瘤内见低信号未强化分隔,6例见裂隙状高信号;最大径线2.4~7.5cm;2例呈圆形、类圆形,6例呈分叶状;8例边缘均较清晰;增强扫描病灶均呈不均匀强化;7例PTs早期强化率大于100%,1例50%且100%;TIC类型1例为流入型,5例为平台型,2例为廓清型。DWI病灶均呈高信号,且ADC值低于正常腺体,PTs平均ADC值为(1.30±0.25)×10-3 mm2/s,正常腺体ADC值为(1.64±0.12)×10-3 mm2/s,二者差异有统计学意义(t=3.375,P0.05)。结论:乳腺PTs的MRI征象具有一定的特征性,结合其临床特点综合分析,可提高其术前诊断准确率。     

乳腺良性叶状肿瘤术中乳腺内整形术10例分析

目的探讨乳腺良性叶状肿瘤临床诊断和治疗方法。方法回顾分析经手术病理确诊为乳腺良性叶状肿瘤10例患者的病历资料。结果乳腺肿块为首发症状且增长快速,术前超声、钼靶、核磁共振等影像学检查准确率50%,空芯针活检术前病理与术后病理相符率90%。局部扩大切除术随访至今未见复发,术中乳腺内成型能保证乳房的外形。结论术前空芯针活检是明确诊断的标准,局部扩大切除术可以作为乳腺良性叶状肿瘤的标准术式,术中乳腺瓣成型术能维持乳房的基本外形,值得推荐。     

乳腺良恶性叶状瘤X线与超声检查诊断现状

叶状瘤占乳腺肿瘤的1%，约占乳腺上皮样肿瘤的2～3％。与纤维腺瘤一样，叶状瘤是由上皮成份及结缔组织基质构成的，但叶状瘤具有更完善的基质细胞结构。内眼观察叶状瘤呈内质。分叶、囊状，Mueler J首先于1838年将叶状瘤描述为“叶状囊性内瘤”，并认为该肿瘤为良性。1931年Lee B报道％，局部复发约为20首例转移性叶状瘤，此后相继有转移性叶状瘤的报道。叶状瘤转移的发生率为6%-22％，并常由于不完全性外科手术切除引起，绝大多数复发病灶其组织学上类似于原发肿瘤，但其侵袭性更强。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.