经纤维支气管镜不同取材方法对肺癌的诊断的影响

目的探讨纤维支气管镜不同取材方法对肺癌的诊断影响。方法2002年至2004年间我院门诊及病房疑诊肺癌行纤维支气管镜检查患者76例,采用钳检/TBLB、刷检、针吸活检(TBNA)等方法获取标本,经病理学或细胞学检查确诊。结果76例确诊为肺癌66例,其中腔内增生型93.9%(31/32),管壁浸润型86.4%(19/22),管外压迫型75.0%(9/14),中央型88.0%(59/67)周围型66.7%(6/9),刷检、TBNA阳性率分别是53.4%(41/76)、78.1%(50/64)、58.8%(20/34),联合三种取材方法阳性率90.8%(69/76);结论纤维支气管镜检查对肺癌的诊断率与病变生长方式、部位、取材方式、技术等有密切关系,联合取材能提高肺癌的诊断率。     

不同取材方法对病理诊断肺癌的价值回顾性分析

目的探讨不同取材方法对病理确诊肺癌的诊断价值。方法回顾性分析我科在2002-2006年8月间病理确诊为肺癌的临床资料。根据肺癌时取材方法不同进行分类统计和分析。取材方法分为胸膜活检法、胸水查脱落细胞、CT引导下经皮肺穿刺法、经纤维支气管镜（简称纤支镜）单纯钳夹活检、单纯刷检、钳夹活检加刷检、针吸活检、针吸活检加刷检、纤支镜肺活检（TBLB）、TBLB加“盲刷”、经纤支镜检查前后痰细胞学涂片。对其诊断肺癌的阳性率进行分析。结果按上述方法中所列顺序,其阳性率分别为35．71％、69．05％、100％、78．3％、52．08％、93．02％、32％、62．86％、30．77％、65．52％、19．06％、56．12％。结论根据肺癌情况不同,采取不同取材方法,对肺癌均有很高的诊断价值。联合不同取材方法比用单一取材方法诊断肺癌的阳性率高。     

纤维支气管镜下联合取材对肺癌的诊断价值

目的　探讨纤维支气管镜下联合取材对肺癌的诊断价值。方法　采用回顾性分析法 ,分别统计钳检、刷检、冲洗及针吸活检 4种不同取材方法对肺癌的检出情况。结果　确诊的 2 60例肺癌患者镜下分为四型 :增生型、浸润型、外压型、正常型 ;钳检、刷检、冲洗、针吸活检的阳性率分别为 83 7%、72 3 %、65 0 %、62 3 % ,联合后总阳性率为 93 8%。结论　纤维支气管镜对肺癌的诊断有重要价值 ;不同取材方法对镜下不同类型肺癌的诊断价值不同 ;4种取材方法中钳检的检出率最高 ,联合运用多种取材方法可明显提高肺癌的诊断准确率     

纤支镜中多种检查在周围型肺癌的诊断价值

目的探讨非直视经纤支镜肺活检联合细胞学检查在周围型肺癌的诊断价值。方法将本院100例最终确诊为周围型肺癌患者的资料进行总结分析。结果 100例患者中非直视经纤支镜肺活检(TBLB)阳性59例,占59%;支气管肺泡灌洗(BALF)阳性25例,占25%;刷片阳性22例,占22%;痰检阳性12例,占12%。TBLB+BALF+刷片法+痰检法阳性74例,占74%。结论非直视经纤支镜肺活检联合细胞学检查对周围型肺癌有较高诊断价值。     

纤维支气管镜在呼吸系统疾病中的应用进展

1897年德国K illian首次从气管内取出骨性异物,开创了硬式内镜进行气管和支气管操作的历史。1967年由日本池田(Ikeda)研制的纤维支气管镜(简称纤支镜)于70年代迅速在我国普及。本文综述如下。1肺癌纤支镜是目前国内外诊断肺癌最常用的方法,包括直视、支气管肺泡灌洗、支气管刷检、支气管肺活检等。对支气管内病变诊断阳性率达70%~100%,对周围性病变为40%~80%。60岁以上老年患者进行纤支镜检查,其肺癌阳性率达53.7%,纤支镜刷检结合钳检阳性率达90%~93%[1]。支气管肺泡灌洗(bronch ial alveolar lavage,BAL)是纤支镜向局部支气管肺泡注入生…     

纤维支气管镜刷检细胞学检查诊断肺癌的价值及影响因素分析

目的探讨纤维支气管镜（纤支镜）刷检细胞学检查诊断肺癌的敏感性、特异性及相关影响因素。方法以手术切除和（或）经纤支镜钳取活检组织病理学诊断结果为标准,对143例可疑肺癌患者的纤支镜刷检细胞学检查结果、涂片质量及纤支镜下表现等进行分析。结果以高级别异型增生及以上级别报告为阳性结果,纤支镜刷检细胞学检查诊断肺癌的敏感性为66．7％、特异性为96．6％;纤支镜活检和刷检结合肺癌检出率为89．3％,显著高于单纯刷检（P〈0．01）、显著低于组织病理学检查（P〈0．05）;纤支镜刷检肺癌检出率退变标本和未退变标本分别为25．0％．72．0％（P〈0．05）,中央型肺癌和非中央型肺癌分别为72．1％、43．8％（P〈0．05）,增生型、管壁浸润型、管外压迫型和正常型分别为81．4％、70．0％、22．2％、41．7％（P〈0．01）。结论纤支镜刷检细胞学检查简便、快捷,诊断肺癌特异性及敏感性均较高,与纤支镜钳取活检联用可提高肺癌检出率;但纤支镜刷检结果受标本质量、肺癌部位和纤支镜下分型等影响,临床医师要综合分析临床资料、排除假阴性。     

纤支镜刷检与病理活检在肺癌诊断中的临床价值

目的探讨纤维支气管镜刷检物涂片细胞学检查与病理活检在肺癌诊断中的临床价值。方法对比分析182例经纤支镜刷检物涂片细胞学检查与病理确诊为肺癌患者的病理诊断情况。结果 182例患者中经纤支镜刷检物涂片细胞学确诊为肺癌阳性126例,占69.2%,经病理活检确诊为肺癌阳性134例,占73.6%,两者共同检测可检出肺癌阳性175例,占96.2%。与其他单一方法比较,阳性检出率明显提高(P<0.05)。结论纤支镜刷检物涂片细胞学检查联合病理活检可明显提高肺癌诊断的阳性率。     

纤维支气管镜联合取材对肺癌诊断的临床价值

目的评价纤维支气管镜检查对肺癌的诊断价值,探讨纤维支气管镜下联合采用多种取材方法对肺癌诊断的临床意义。方法回顾性分析109例肺癌患者,经纤支镜检查采用钳夹、刷检、灌洗联合取材方法,获取标本,经病理学检查或细胞学检查确诊为肺癌,比较三种不同取材方法及联合取材方法获取肺癌诊断阳性率。结果钳夹、刷检、灌洗对肺癌诊断的阳性率分别是82.02%、69.44%、55.96%,三种方法联合后总阳性率为98.86%,联合取材与单一方法取材比较差异有显著性（P〈0.05）。结论纤支镜检查是确诊肺癌的重要手段之一,联合取材可以提高肺癌诊断的阳性率。     

经纤支镜针吸活检对肺癌的诊断价值

经纤支镜针吸活检对肺癌的诊断价值新汶矿务局中心医院（２７１２３３）孙启洪为了进一步提高纤维支气管镜（纤支镜）对肺癌诊断的阳性率，我们在行钳检和刷检的同时采用针吸活检（针吸），阳性率明显提高。现将８３例肺癌患者的检查结果报告如下。１资料与方法１．１本组...     

经支气管镜针吸结合刷片和钳夹活检在支气管壁内和管壁外恶性病变的诊断价值

目的探讨经支气管镜针吸与刷片和钳夹活检技术联合,对支气管壁内和管壁外恶性病变进行病理取材的诊断价值。方法在胸部CT提示肺门、纵隔淋巴结肿大(大于1cm)合并肺部病变、纵隔肿物的32例患者,予常规纤维支气管镜检查经支气管镜针吸活检(TBNA)术并行刷检和钳检,对获取的标本进行细胞学及组织病理学检查。结果 32例最终均确诊为胸部恶性肿瘤,经支气管镜针吸活检(TBNA)、刷检、钳检的阳性检出率分别为59.4%、65.5%和40.0%,三者联合取材的阳性率84.4%(趋势检验χ~2=6.0,P值0.05)。所有患者均无明显的并发症。结论联合取材的方法安全、方便,还具有创伤小,阳性率高等优点,对胸部恶性肿瘤的诊断和分期判定有很大帮助。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.