长骨釉质瘤10例临床病理形态及免疫表型分析

目的 研究釉质瘤临床病理特点,分析免疫组化在釉质瘤、骨性纤维结构不良(OFD)样釉质瘤及骨性纤维结构不良的诊断与鉴别诊断中的作用,探讨三者之间的关系.方法 回顾性分析发生于胫、腓骨的釉质瘤10例,其中OFD样釉质瘤2例;并与胫、腓骨发生的15例OFD进行比较.结合文献讨论这些病例的临床表现、病理形态、免疫组化及随访结果.结果 10例釉质瘤均位于胫、腓骨皮质,其中8例镜下有明确的上皮样分化,2例镜下见骨性纤维结构不良背景下散在少数活跃的上皮样梭形细胞,经免疫组化检测后支持OFD样釉质瘤.釉质瘤患者均行肿瘤广泛切除,随访4个月～5年(平均4.3年)无复发.OFD患者接受刮除植骨治疗,随访3个月～3年(平均2.2年)无复发.结论 釉质瘤为少数低度恶性骨原发肿瘤之一,诊断依据为镜下见到明确的上皮样成分并经免疫组化支持.需与临床、影像学密切结合并充分取材行上皮抗原免疫组化检测方能避免漏诊.     

普通型骨肉瘤肿瘤性骨样组织形态学及免疫组化观察

目的 探讨普通型骨肉瘤肿瘤性骨样组织形态学和免疫组化特征,为鉴别诊断提供依据.方法 采用HE染色,光镜下观察56例普通型骨肉瘤肿瘤性骨样组织的形态学特征,对其中9例进行Osteocalcin(OC)和Osteonectin(ON)免疫组化标记.结果 56例普通型骨肉瘤组织中均有数量不等、形态各异的肿瘤性成骨,其共同特点是肿瘤性骨样组织存在于恶性肉瘤细胞背景之中,典型的肿瘤性骨样组织呈不规则花边状、网格状或金属丝样,具有异型性的肿瘤性成骨细胞;可见肿瘤性骨样组织浸润于正常残留骨之间;6例肿瘤细胞和肿瘤性骨样组织OC标记阳性着色,7例ON标记为阳性.结论 在识别肿瘤性骨样组织的同时,要注意与反应性成骨、残存骨、胶原束及软骨成骨等鉴别.鉴别困难时,可结合OC免疫组化标记进行识别,ON区别骨样组织和胶原纤维帮助不大.     

小腿骨性纤维结构不良样釉质瘤发展成经典型釉质瘤1例报告（英）

釉质瘤是一种低度恶性双相性肿瘤，占所有骨原发肿瘤的0．4％。经典的釉质瘤既有上皮细胞成分又有骨纤维成分，二者以不同方式及比例混合；它的亚型骨性纤维结构不良样釉质瘤有时与骨性纤维结构不良很难鉴别，只有通过仔细的镜下观察同时进行免疫组化才能确定。而因为它们的预后不同，就需要诊断明确才能指导合理的治疗。     

髋关节囊内骨样骨瘤MR影像学特征及诊断价值

目的 探究髋关节囊内骨样骨瘤的MR影像学特征及鉴别价值.方法 回顾性分析2020年10月至2021年10月在重庆三峡医药高等专科学校附属医院就诊的18例髋关节囊内骨样骨瘤和10例骨母细胞瘤患者的临床资料,对比两种患者的MR影像学特征并分析其诊断价值.结果 髋关节囊内骨样骨瘤和骨母细胞瘤在T1WI、T2WI、瘤巢钙化、关...     

颌骨骨肉瘤3例临床病理观察

目的本文报告3例罕见的颌骨骨肉瘤并加以讨论。方法回顾性分析近3年来发现的3例颌骨骨肉瘤,探讨其临床、影像学、病理形态学、免疫组化及分子病理学特征,并结合文献资料讨论相关的鉴别诊断。结果3例颌骨骨肉瘤患者年龄分别为49岁、46岁和51岁,其中2例肿瘤位于左上颌骨,1例位于右上颌骨。病理诊断均为颌骨骨肉瘤,其中1例为继发性。结论颌骨骨肉瘤的发病年龄、临床特征及形态学特点均与四肢长骨骨肉瘤有所不同;临床、影像、病理的综合分析,并辅以必要的免疫组化检测可及时诊断。     

骨原发性上皮样血管内皮瘤4例临床病理分析

目的探讨骨原发性上皮样血管内皮瘤(EHE)的临床病理特征及诊断和鉴别诊断,以提高对该病变的认识。方法观察4例骨原发性EHE的临床病理特征及免疫组化表型特征,并结合文献分析讨论。结果骨EHE好发于年轻男性,男女之比为2∶1。主要临床表现为局部疼痛,其临床病程长短不一,可复发转移。病变以多中心性居多,X线下为无特征性的溶骨性病变。镜下上皮样瘤细胞呈条索状或巢团状分布于黏液样或透明变性的间质中,形成不同发育阶段的血管,可见单细胞血管腔。免疫组化:瘤细胞CD34、CD31、F8因子、vimentin和广谱CK(+)。结论骨EHE是一种少见的血管源性恶性肿瘤,具有独特的临床病理学特征及预后,临床及影像学诊断有困难,病理学检查是最佳诊断手段,应注意与感染、转移癌及其他良性病变相鉴别。     

骨上皮样血管内皮瘤2例报道并文献复习

目的 探讨骨上皮样血管内皮瘤的临床病理学特征和鉴别诊断。方法 观察和分析2例骨上皮样血管内皮瘤的病理形态特征和免疫组化标记，并结合文献复习，总结骨上皮样血管内皮瘤的临床病理学特点和鉴别诊断。结果 最常见的临床症状是骨疼痛；X线呈溶骨性骨破坏；肿瘤多呈分叶状，瘤细胞呈条索状、巢状或散在分布于透明变性的黏液基质中；CD34、CD31、CK和vimentin( )，EMA部分( )。结论 原发于骨的上皮样血管内皮瘤是一种少见的低度恶性的血管源性肿瘤，需与转移癌、骨上皮样血管瘤和上皮样血管肉瘤等鉴别。     

肺上皮样血管肉瘤临床病理观察

目的探讨肺上皮样血管肉瘤(PEA)的临床病理特征、生物学行为和鉴别诊断。方法分析1例肺上皮样血管肉瘤的临床表现、组织学特征、免疫组化结果并行文献复习。结果本例镜下显示瘤组织大部分以梭形细胞为主,弥漫片状分布,形似纤维肉瘤,可见瘤细胞形成的空泡状单细胞性血管腔,部分呈上皮细胞巢状结构的区域见瘤组织呈条索状分布,背景广泛黏液样变,坏死及核分裂易见,并伴有淋巴结转移。免疫组化示肿瘤细胞vimentin、CD34、和CD31(+),EMA少量灶性(+);Ki-67增殖指数不均一,梭形细胞区20%～70%。结论肺上皮样血管肉瘤罕见,具有独特的病理形态学特征,高度恶性,预后不良。需要与上皮样血管内皮细胞瘤、纤维肉瘤、恶性孤立性纤维性肿瘤、低分化腺癌、恶性间皮瘤、转移性胃肠间质瘤等相鉴别。     

乳腺原发性骨肉瘤临床病理观察

目的探讨乳腺原发性骨肉瘤的临床病理学特征、鉴别诊断、治疗及预后。方法应用光镜观察及免疫组化染色对1例乳腺原发性骨肉瘤进行临床病理分析,并复习相关文献。结果患者临床症状和辅助检查无特异性,镜下示:大部分区域见肿瘤性骨样组织,骨样组织被瘤细胞包绕,瘤细胞呈梭形、卵圆形、多边形,并可见破骨细胞样多核巨细胞。免疫组化:瘤细胞vimentin(+)、破骨样多核巨细胞CD68(+),ER、PR、Her-2及上皮标记均(-)。结论乳腺原发性骨肉瘤极罕见,确诊需依据临床病理形态学特点及免疫组化,治疗以手术为主,可选用单纯乳房切除或改良根治术。     

骨原发性假肌源性/上皮样肉瘤样血管内皮瘤4例临床病理观察

目的 探讨骨原发性假肌源性/上皮样肉瘤样血管内皮瘤的临床病理特征.方法 回顾性分析4例骨原发性假肌源性/上皮样肉瘤样血管内皮瘤的临床资料、病理学形态及免疫组化表型等并复习相关文献.结果 骨原发性假肌源性/上皮样肉瘤样血管内皮瘤好发于青少年,有分布于同侧肢体多处骨的趋势,多见于下肢,镜下包含梭形细胞和上皮样细胞两种成分,...     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.