针吸肺活检并发气胸与各种危险因素的关系探讨

目的　探讨经胸针吸肺活检 (TNAB)并发气胸与各种危险因素的关系。方法　对 42 4例符合穿刺指征患者予同样的方法行经胸针吸肺活检 ,分析患者年龄、性别 ,穿刺针的直径 ,病灶的直径、深度、肺叶位置和患者肺功能与气胸的关系。结果　出现气胸 43例 ,发生率 10 .1%。年龄与气胸发生有关 ,气胸组平均年龄高于无气胸组 (P <0 .0 1) ,直径小的病灶增加气胸发生率 (P<0 .0 1)。位置深的病灶增加气胸发生率 (P <0 .0 1)。气胸组FEV1 %、FEV1 /FVC比率低于无气胸组 (P <0 .0 1) ,穿刺针的外径粗细与气胸发生率有关 ,外径粗气胸发生率高 (P <0 .0 5 )。结论　年龄、病灶直径和深度、肺功能和穿刺针直径与经胸针吸肺活检并发气胸有关 ,术前予肺功能检测是必要的。     

腮腺高分化黏液表皮样癌10例的临床病理特征及诊断探讨

目的：提高腮腺高分化黏液表皮样癌(MEC)诊断准确率。方法：回顾分析本院口腔科1987年1月～2003年1月收治的10例腮腺高分化MEC的病理特征和诊断资料。结果：10例中有2例误诊为淋巴结肿大，4例误诊为多形性腺瘤。本组行细针吸取细胞学检查2例中，l例提示MEC，经术中所示和术后标本证实；另l例由于抽取细胞数量少、诊断者临床经验不足，提示为良性病变，行冷冻切片证实为高分化MEC。肿瘤有不规则的浸润性边界，由充满黏液的囊腔和不规则的肿瘤巢构成，肿瘤细胞呈良性型核，核分裂像罕见。结论：腮腺高分化MEC常被误诊为多形性腺瘤，术前行细针吸取细胞病理学检查有助于高分化MEC的诊断。     

Fabry's disease without angiokeratomas showing unusual eccrine gland vacuolation.

An unusual case of Anderson-Fabry's disease with renal damage and bilateral corneal deposits but without angiokeratomas is presented. Diagnosis was made by renal biopsy. Typical foamy transformation of endothelium, mesangium, tubular epithelial cells, vascular smooth muscle, and fibroblasts of kidney biopsy and similar changes of myoepithelial, perineural, and endothelial cells on the skin biopsy were observed. At electron microscopy, 'fingerprint-like' myelin figures were seen. The epithelial cells of eccrine sweat glands showed striking vacuolation but myelin figures were not seen. We suggest that electron microscopic study of skin biopsies is indicated in the evaluation of patients clinically suspected of having Fabry's disease.     

Comparison of Injection Materials for the Elevation of Gastric Mucosa Prior to Endoscopic Mucosal Resection

Endoscopic mucosal resection (EMR), namely strip biopsy, to eradicate gastric mucosal lesions requires certain special techniques, including submucosal injection of appropriate agents. This experimental study using dogs was conducted to compare, with regard to the degree of duration of mucosal elevation and subsequent histologic changes of the gastric wall, three injection materials; physiological saline, hypertonic saline with epinephrine (HSE) and 10% soybean oil. The duration of mucosal elevation which should be sufficient for the EMR procedure did not differ between the three agents. The post-injection histologic changes included vessel dilatation in the peri-muscularis mucosae, dilatation of the lymphatic channels and vessel congestion. These changes appeared in all injection material groups, and the vessel congestion was found to be more conspicuous in the HSE group. All EMRs in this series were performed by single snare cutting, which was also evaluated. The margin of the stripped material was well limited to the submucosal layer in all cases, but the depth of the ulcers formed varied. The healing process of the ulcer for the first 4 weeks was delayed in the soybean oil group. Although there were few cases of perforation in this experiment and some subjects had adhesion between the gastric serosa and adjacent organs, the single snare method could be applicable for clinical use by skilled hands.     

STEREOTACTIC FINE NEEDLE ASPIRATION IN THE MANAGEMENT OF MAMMOGRAPHIC ABNORMALITIES DETECTED IN BREAST SCREENING

Background: Fine needle aspiration (FNA) is used routinely in the management of palpable breast lumps; with the implementation of the stereotactic technique its use has been extended to the investigation of mammographic abnormalities. The advent of breast screening means that many mammographic abnormalities will be detected; because routine open biopsy is impractical and undesirable, stereotactic fine needle aspiration becomes the method of choice for investigation. Method: Within a 28 month interval, 81 Chinese women underwent stereotactic FNA in Kwong Wah Hospital, Hong Kong. Results: Fifty-one women (62.9%) had a benign cytology result and no further investigations were required. Inconclusive results were obtained in 18.6% of the aspirates. Open biopsy was required in 16 women (19.8%). Conclusion: Stereotactic FNA is very useful in the exclusion of malignancy and the avoidance of open biopsy in asymptomatic women who have mammographic abnormalities.     

Distal muscular dystrophy of Miyoshi type

Miyoshi myopathy (MM) is a rare distal myopathy that mainly occurs in Japan. And that is characterized by prominent involvement of the gastrocnemius muscles. Here we report two patients, brother and sister, from a German family. Onset of the disease was at the age of 20 and 22 years, respectively. In both siblings, there was an early and predominant involvement of the gastrocnemius muscles. Creatine kinase activity was elevated 37- to 95-fold above normal. Electromyography revealed fibrillations, positive sharp waves and a myopathic pattern, particularly in the distal muscles of the lower limbs. Histology of the gastrocnemius muscles showed myopathic changes consistent with muscular dystrophy. Occurrence in these two siblings but in no other family members was indicative of an autosomal-recessive inheritance. Our report indicates that MM may also be found in Germany, and that it should be considered in the differential diagnosis of distal myopathies. Received: 25 April 1996 Received in revised form: 26 July 1996 Accepted: 26 August 1996     

原发性脑瘤的CT导引针吸细胞学诊断

作者应用CT导引下脑深部病灶针吸巴氏涂片细胞学诊断原发性脑瘤,对1988～1989年1年中诊断的8例胶质瘤进行丁分析。脑组织质软易于针吸且创伤小,所获标本可以制做切片与涂片。在形态学方面,发现在神经胶质纤维中星形细胞瘤瘤细胞的密度明显较正常或胶质细胞增生的细胞密度为大,且具有一定异型性,故诊断敏感性高。对CT导引下针吸的禁忌症、并发症及适应症进行了初步探讨。作者还特别指出,同时行组织学与细胞学诊断可以相互弥补不足,防止采用单一方法可能导致的检查失败。     

骨肿瘤的针吸细胞学诊断

骨肿瘤诊断中，常用的针吸取材切片诊断因所获标本较小，不足供切片和诊断需要而造成漏诊及误诊。采用针吸标本做涂片供细胞学诊断，可弥补此类不足。用此法对可触及骨肿物及Ｘ线表现为骨质改变的病例１５５例行巴氏涂片诊断和分类的探讨，其中１２例无组织学结果或失去随访而资料不全，对１４３例资料完整有随访的病例进行了与组织学对照分析的研究。良性及恶性骨病损１４３例中，细胞学定性与分类符合者１１９例，总符合率８３．２％，恶性肿瘤９８例中９６例为细胞学所定性，细胞学敏感度高达９８％，对误诊及漏诊的原因进行了分析，结果表明，细胞学可以作为骨肿瘤的简便快速而准确的筛选和诊断方法之一。     

Percutaneous lung biopsy

A case is reported in which percutaneous lung biopsy was followed by haemorrhage into the tracheobronchial tree. Hypoxia followed, precipitating a cardiac arrest. The haemorrhage was isolated by the insertion of a double-lumen tube. Complications arising from this method of biopsy are reviewed and the measures necessary to control the potentially fatal problems are discussed.