Intracerebral vascular occlusion in familial erythrophagocytic lymphohistiocytosis: a case report of two siblings

Neuropathological findings in two siblings with familial erythrophagocytic lymphohistiocytosis (FEL) are reported. Case 1 showed the typical neuropathological findings of FEL with lymphohistiocytic infiltration of the leptomeninges and perivascular spaces. A characteristic erythrophagocytosis was detected in inguinal lymph nodes, lung and bone marrow. Case 2 revealed calcification and necrotic lesions in the brain. In the necrotic areas, parenchymal calcification, vascular medial calcification, and occlusion of many vessels due to subendothelial fibrosis were detected. The areas of necrosis correlated with the distribution of occluded vessels. These changes were most prominent in putamen, internal capsule, thalamus and dentate nucleus. Hypercytokinemia is suspected to be the underlying mechanism for the clinical and laboratory findings in patients with FEL, although the relationship to the vascular pathology is unclear.     

48例肺癌诊断与探讨

本文对48例肺癌进行了临床分析,对肺癌的早期诊断及各种检查方法进行了讨论。     

风湿性二尖瓣狭窄心肌病理改变与心肌运动的关系

目的 :探讨风湿性二尖瓣狭窄 (Mitralstenosis ,MS)患者心肌病理改变与心肌运动的关系 .方法 :MS患者 2 2例术前行常规心脏超声及组织多普勒成像 (Dopplertissueimag ing,DTI)检查 ,于心尖四腔切面记录室间隔侧二尖瓣环长轴方向射血期频谱S波和舒张期频谱D波峰值及心电图R波至频谱S波起始点的时间T ,选取 3个波幅最大的心动周期 ,算出此 3个心动周期的平均值S3 、D3 和T3 ;二尖瓣置换术中切取左室乳头肌行病理检查 .结果 :微动脉Di/Do与D3 呈正相关 ,(r =0 .5 0 ,P <0 .0 5 ) ;心肌纤维化程度与T3 呈正相关 ,(r=0 .6 8,P <0 .0 5 ) ;而S3 与D3 呈正相关 ,(r =0 .4 3,P <0 .0 5 ) .结论 :术前DTI检查测量D3 及T3 ,可以反映心肌病理变化 ,有助于对MS患者手术适应证的掌握及对预后的判断     

左半结直肠癌临床与病理学特点及诊治分析

目的　探讨左半结直肠癌 (LCRC)临床病理特点及诊治对策。方法　采用直接结肠镜检查加病理活检的方法确诊LCRC 85例 ,其中 37例经手术治疗。结果　本组 50岁以上占 60 %。农民占 73 %。首发症状至确诊 <3个月占 56 .5 % ,<1年占 89.4%。便血、腹痛腹胀、排便习惯改变、肛门异常是LCRC常见症状 ,便血为主要表现占 83 .5 % ,始发便血 56例 ,占 56/ 71 (76 .87% )。本组临床误诊率 63 .5 %。活检符合率 88.57%。病理形态以隆起 (肿块型 85 .88% )管状腺癌 (98.36 % )为主。 37例手术DUKES分期DaDb1 7例为可切除可治愈癌 ,占 45 .95 %。病程 <3个月DaDb 47.4% ,DcDd 52 .6 %。手术率乙状结肠以上癌 2 0 / 2 6(76 .92 % ) ,肛直肠癌 1 7/59(2 8.81 % )。结论　 >50岁属LCRC高发人群 ,为重点结肠镜检查对象。便血是LCRC始发主要表现和重要的结肠镜检查指征 ,应提高对便血的认识 ,放宽镜检范围。LCRC一经诊 ,应及早手术 ,这是切除或治愈LCRC的重要手段。     

关节镜下肩袖缝合术治疗肩袖撕裂

目的探讨关节镜下肩袖缝合术治疗肩袖撕裂的手术方法和临床效果。方法2002年12月至2005年10月，对27例肩袖撕裂患者行关节镜下肩袖缝合术，25例获得1年以上随访，其中男12例，女13例；年龄35～67岁，平均54．3岁；左肩6例，右肩19例，涉及优势侧19例。10例滑囊侧部分撕裂，1例滑囊侧及关节侧均有部分撕裂，14例全层撕裂。术前均拍摄肩关节正位和冈上肌出口位X线片，21例行B超检查，23例行MR或MRA检查。全部病例行肩峰下滑囊切除及前肩峰成形术。肩袖修复方式：1例直接行断端缝合，15例应用缝合锚钉行肩袖止点重建，9例联合应用断端缝合及缝合锚钉技术。分别在术前和最终随访时采用UCLA肩关节评分标准进行评价。结果随访时间1～3年，平均23个月。术后平均UCLA评分为（32．3±t2．3）分。手术前后疼痛评分平均为（2．6±t0．9）分和（8．6±1．4）分（P=0．000），功能评分平均为（5．0±1．8）分和（9．1±1．0）分（P=0．000），肩关节主动前屈评分平均为（3．6±1.5）分和（4．9±10.3）分（P=0．000），前屈肌力评分平均为（4．0±0．6）分和（4．7±0．5）分（P=0．000），差异均有统计学意义。优8例、良17例，所有患者均对手术效果表示满意。结论关节镜下肩袖缝合术是治疗肩袖撕裂的有效方法。术中应有效地控制出血，适度进行肩峰成形，正确识别撕裂的形状，充分松解粘连并采用恰当的缝合方式。手术创伤小、恢复快，其疗效可达到切开手术水平。     

Massive residual dental cyst: Case report

A case report is presented of a massive residual dental cyst that involved over half an edentulous mandible. Presentation, diagnosis and management of the massive cyst is discussed.     

血清谷氨酰转肽酶含量测定在慢性乙型肝炎中的临床意义

目的探讨血清谷氨酰转肽酶（GGT）含量变化在慢性乙型肝炎（CHB）不同程度肝脏病理损害中的变化规律及临床意义。方法测定70例CHB患者血清ALT、AST、GGT水平，同时行肝活体组织检查，对肝脏进行炎症分级和纤维分期。分析ALT、AST、GGT与CHB之间的关系。结果（1）ALT、AST、GGT随炎症程度和纤维化程度的上升而上升，但到G4和s4后则下降。GGT随ALT、AST的升高而升高，ALT、AST和GGT的相关系数分别为：0．322、0．328（P〈0．05）。在保肝治疗后，ALT较快降至正常且GGT保持在一个较低水平的为轻度CHB，而随着ALT下降，GGT仍持续在一个较高水平的为中度及重度CHB，其中重度CHB的GGT水平有所波动。结论血清GGT比ALT、AST更准确的反映肝脏的炎症程度，GGT的活动度给临床判断慢乙肝的炎症提供了重要的判断依据。     

The pattern of amyloidosis in a Malaysian patient population

Congo red screening of 27,052 routine biopsy specimens from 22,827 patients over a 5 1/2-year period in the Department of Pathology, University of Malaya detected 186 cases of amyloidosis. The categories of amyloidosis encountered and their prevalences in relation to each other were: systemic AL (5.9%); systemic AA (3.2%); isolated atrial (14%); primary localized cutaneous (7.5%); other primary localized deposits (3.2%); localized intratumour (58%); and dystrophic (8.6%). A third of patients with systemic AL amyloidosis had coexistent immunocyte abnormality. The commonest underlying pathology for systemic AA amyloidosis was leprosy. Notable among the types of localized amyloidosis revealed by this study were isolated atrial amyloidosis, which appeared to complicate chronic rheumatic heart disease, and intratumour amyloidosis complicating nasopharyngeal carcinoma. Other tumours in which amyloid deposits were observed included basal cell carcinoma, islet cell tumour and medullary carcinoma of the thyroid. Dystrophic amyloidosis was observed in fibrotic tissues, such as damaged cardiac valves and osteoarthritic joints. Heredofamilial amyloidosis, senile systemic amyloidosis and degenerative cerebral amyloidosis were notably absent from this study.     

Evidence-based medicine, medical decision analysis, and pathology

Recent advances in molecular pathology and other technologies such as proteomics present pathologists with the challenge of integrating the new information generated with high-throughput methods with current diagnostic models based mostly on histopathology and clinicopathologic correlations. Parallel developments in the field of medical informatics and bioinformatics provide the technical and mathematical methods to approach these problems in a rational manner. However, it remains unclear whether pathologists or other medical specialists will become primarily responsible for the development and maintenance of these multivariate and multidisciplinary diagnostic and prognostic models that are hoped to provide more accurate, individualized patient-based information. Evidence-based medicine (EBM) and medical decision analysis (MDA) are relatively new disciplines that use quantitative methods to assess the value of information, differentiate fact from myth, and integrate so-called best evidence into multivariate models for the assessment of prognosis, response to therapy, selection of laboratory tests, and other complex problems that influence individual patient care. We review from an epistemological viewpoint the current approach to information in pathology and describe some of the concepts developed by the practitioners of EBM and MDA.