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1.
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。 相似文献
2.
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. 相似文献
3.
Sergio Muntoni Paola Tagliamonte Federico Sirigu Giovanni Umberto Corsini 《Acta diabetologica》1973,10(6):1300-1307
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. 相似文献
4.
P. Brar G.Y. Kwon I.I. Egbuna S. Holleran R. Ramakrishnan G. Bhagat P.H.R. Green 《Digestive and liver disease》2007,39(1):26-29
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. 相似文献
5.
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。 相似文献
6.
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。 相似文献
7.
氯硝柳胺悬浮剂的毒性评价 总被引:2,自引:2,他引:2
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。 相似文献
8.
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 相似文献
9.
Marc B. Taub Thomas A. Peyser J. Erik Rosenquist 《Journal of diabetes science and technology》2007,1(5):685-694
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. 相似文献10.
Toshihide Iijima M.D. 《Diseases of the colon and rectum》1988,31(1):46-49
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. 相似文献
11.
Alessandra Strocchi MD Carol J. Ellis AA Julie K. Furne BS Dr. Michael D. Levitt MD 《Digestive diseases and sciences》1994,39(3):494-497
The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H2-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25. 相似文献
12.
治疗高血压药物的经济学评价 总被引:3,自引:0,他引:3
重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。 相似文献
13.
目的:探讨沈阳市代谢综合征(MS)人群肾脏损害情况。方法:选取辽宁省城市体检人群与社区人群进行分层抽样调查,共调查2000人,其中体检人群1000人,社区人群1000人(来自辽宁省各城市)。根据MS的诊断标准,研究对象被分为超重肥胖组(460人)和正常体重组(1540人),高血糖组(140人)和正常血糖组(1860人),高血压组(399人)和正常血压组(1601人),血脂异常组(486人)和血脂正常组(1514人),比较各分组间肾脏损害的患病率。结果:调查人群中肾脏损害患病率为15%,男性与女性之比为1:1。超重肥胖组和非超重肥胖组肾脏损害患病率分别为10%和1%;高血糖组和正常血糖组肾脏损害患病率分别为10%和1%;高血压组和正常血压组肾脏损害患病率分别为10%和2%;血脂异常组和血脂正常组肾脏损害患病率分别为10%和1%,以上两组间比较差异均有显著性(P0.01)。结论:辽宁省城市代谢综合征患者的肾脏损害患病率较正常人群显著升高。 相似文献
14.
目的 了解南通市老年人的生命质量及其影响因素.方法 2010年7月应用欧洲五维健康量表(EQ-5D)对南通市994例>60岁的老年人进行问卷调查,探索性因子分析生命质量的影响因素.结果 英国权重计算城市老年人生命质量指数得分均数(0.590±0.092)高于农村老年人(0.560±0.115),农村老年人得分高于养老院老年人(0.447 ±0.154).社会经济因素、闲暇生活方式、慢性病、睡眠食欲、婚姻家庭和社会支持是影响老年人生命质量的主要因子.结论 政府应完善养老保险和医疗保险制度,加强老年人慢性病的健康管理,促进居家养老服务体系建设. 相似文献
15.
目的 探讨糖尿病肾病血液透析中不同护理模式的护理效果.方法 选择该院2018年3月—2019年3月收治的糖尿病肾病患者72例.该次选取的病例均拟行血液透析治疗,按照随机数表将患者分为对照组(35例)和观察组(37例),其中对照组在患者血液透析期间行常规基础护理,观察组行优质护理干预,观察两种不同的护理模式对患者血液透析... 相似文献
16.
胆囊腺肌增生症23例临床分析 总被引:1,自引:0,他引:1
目的探讨胆囊腺肌增生症的病因、诊断和治疗方法。方法在1046例胆囊切除术中,对病理检查确诊的23例胆囊腺肌增生症的临床资料进行回顾性分析,患者术前均行超声、CT或MRI检查。结果23例胆囊腺肌增生症临床表现与慢性胆囊炎胆石症类似。病变大体形态:局限型13例(均位于胆囊底部)、节段型7例和弥漫型3例。23例均行胆囊切除,合并胆囊结石6例,合并胆囊炎14例。结论胆囊腺肌增生症是一种好发于成年人的胆囊壁增生性病变,此病常与慢性胆囊炎、胆石症并存,临床诊断困难,确诊需依赖病理检查。联合超声、CT和MRI等影像学检查可提高术前诊断准确度。目前手术是治疗的最好方法。 相似文献
17.
18.
G. Rock 《Vox sanguinis》2011,100(2):169-178
Introduction Current methods for pathogen inactivation of plasma involve four major processes using solvent–detergent (SD), methylene blue (MB), amotosalen and riboflavin as additives. Three of these methods involve the use of visible or ultraviolet light. Methods A comparison of the four methods was made using publications in Medline, Pubmed, Embase and Biosis to obtain data on the logistics of use, the quality of the plasma proteins and the effectiveness of pathogen inactivation. Results Three of the methods, MB, amotosalen and riboflavin, are designed for use in a blood bank; the SD method is generally applied at a centralized manufacturing centre and involves large plasma pools. All methods result in a reduction in protein values with the per cent retention of FVIII activity in the range of 67–78% and fibrinogen of 65–84%. Protein S and alpha2‐antiplasmin are lower following solvent–detergent treatment. Alterations in fibrinogen structure have been reported with methylene blue. Discussion Three of the methods are designed for small volume use in a blood bank. All four methods have some effect on the coagulant proteins; however, the final concentrations are within regulated limits. While there is variability in the effectiveness against pathogens, direct comparison is difficult because of the methodologies used. Nonetheless, all are effective in inactivating HIV and other lipid‐enveloped pathogens. Clinical studies on the effectiveness of these products are surprisingly sparse, and no randomized clinical trials have yet been performed with amotosalen or riboflavin plasmas. 相似文献
19.
目的:探讨主动脉窦瘤的诊断及治疗方法。方法:回顾性分析2000年2月~2007年12月在我院诊治的28例主动脉窦瘤的临床资料。全部患者均在全身麻醉体外循环下行心内直视修补术,心肌保护采用经升主动脉根部顺行灌注或切开后经冠状动脉开口直接灌注冷血停跳液。右房切口4例,右室流出道切口9例.经主动脉直接缝合破口后再经心腔切口补片加强窦壁15例。其中12例同期行主动脉瓣置换术。结果:本组患者无手术死亡,术后因活动性出血二次开胸止血1例,切口感染1例,经换药处理治愈出院。随访3个月~5年。所有病人都自觉症状消失,心功能明显改善。能从事正常工作或一般体力劳动,无抗凝意外事件发生。结论:术前正确的诊断、术中选择恰当的手术方式是成功治疗主动脉窦瘤的关键因素。 相似文献
20.
M. McCarthy P. Cassell T. Tran L. Mathias L.M. 't Hart J.A Maassen C. Snehalatha A. Ramachandran M. Viswanathan G.A. Hitman 《Diabetic medicine》1996,13(5):420-428
In 79 South Indian nuclear pedigrees ascertained via probands with NIDDM and both parents living, parental diabetic status was established through previously diagnosed NIDDM (n = 97) or oral glucose tolerance testing (n = 61). There was no significant difference between diabetes prevalence in mothers and fathers (60 vs 53 (76 % vs 67 %), respectively, p = 0.22). ‘Age at diabetes diagnosis’ survival curves did differ according to parental gender (p = 0.02) but this may reflect gender differences in health provision rather than pathophysiology. No maternal excess effects of the magnitude evident in previous studies were detected, suggesting either ethnic differences or overestimation of the maternal effect when reported histories of parental diabetes have been used. The tRNALeu(UUR) gene region was studied for diabetes-associated variation given the role of mutations in this gene in some pedigrees displaying maternal transmission of NIDDM. None of 142 unrelated South Indian NIDDM subjects displayed the MELAS mutation at nt3243. However, sequencing identified two variants of potential importance: (a) at nt3290 in the tRNALeu(UUR) gene, seen in 7/142 diabetic and 1/85 control subjects (p = 0.11), (b) at nt3316 in the ND1 gene (4/142 vs 1/85 subjects, respectively (p = 0.51)). Further studies are needed to determine the relevance of these variants to the development of NIDDM. 相似文献