阻塞性黄疸:PTC下胆管钳夹活检的技术方法学研究

目的探索切实可行的胆管病理学检查新途径.资料与方法连续92例阻塞性黄疸患者接受经皮肝穿刺胆管造影(PTC)和经皮肝穿胆管引流(PTCD)治疗.PTCD过程中,影像监测下经皮经肝胆管穿刺,向胆管内引入活检钳对梗阻段钳夹活检,行组织病理学检查.统计学分析用χ2检验或Fisher确切概率计算法,以α=0.05作为检验水准.结果 92例钳夹活检患者90例成功获得组织块,技术成功率97.83%(90/92).钳夹活检敏感性为88.04%,63例胆管癌性恶性肿瘤钳夹活检敏感性较25例非胆管癌性恶性肿瘤高(93.65%比72.00%,P＜0.05).结论PTC下胆管钳夹活检操作简单,创伤小,敏感性高,是一种值得推广的胆管病理学诊断新途径.     

CT图象的面罩式覆盖法定量诊断脂肪肝

目的　探讨脂肪肝的脂肪浸润程度的无创性检查方法及临床意义。方法　用 GE 30 0 0 I CT机扫描 36例脂肪肝患者肝脏、脾脏 ,用 CT机配备软件处理数据 ,面罩式覆盖法计算肝脏各个层面的脂肪面积与对应层面肝脏面积 ,并得出比值 (脂肪浸润指数 )。用生化仪检测肝功能指标。肝穿刺病理检测肝组织内脂肪浸润程度。结果　平均脂肪浸润指数与肝功能状态呈显著正相关 ,亦与肝穿刺的病理结果呈正相关 (r=0 .86 5 ,P<0 .0 1)。结论　 CT图象面罩式覆盖法对脂肪浸润的定量分析是诊断脂肪肝可靠的无创性检查方法 ,对非均匀性脂肪肝该方法优于肝穿刺     

多发性肌炎与皮肌炎(附25例报告)

多发性肌炎与皮肌炎25例,其中多发性肌炎21例,皮肌炎2例,多发性肌炎或皮肌炎伴发恶性肿瘤2例。从临床表现、生化检查、肌电图及肌肉活检等方面进行分析,提出多发性肌炎与皮肌炎的诊断条件。本组均采用皮质类固醇治疗,5例合并免疫抑制剂治疗,其中临床治愈4例,显著好转10例,好转5例,无效2例,死亡4例。     

Fine-needle cytology of an eccrine spiradenoma of the breast: diagnosis made by a holistic approach.

Eccrine spiradenoma is a rather rare adnexal tumor of the skin. When the clinical presentation is that of a breast neoplasm, diagnosis can be difficult. As cytology was a new procedure for this tumor, the approach of choice appeared to be a holistic one. The cytologic picture showed bland groups of uniformly sized cuboid cells with scant cytoplasm, round to ovoid nuclei, and inconspicuous nucleoli, while in the groups rosettelike structures could be discerned. Only by integrating the data of clinical history, inspection, palpation, reaction on breast puncture, and immunologic findings could the diagnosis be made.     

Needle tract recurrences after closed biopsy for sarcoma: Three cases and review of the literature

Background: Percutaneous closed needle biopsy of musculoskeletal neoplasms has gained in popularity. However, it remains controversial whether or not to resect the needle tract for fear of a local recurrence. A single published case report exists, noting the lone tract recurrence of an extremity skeletal osteosarcoma. Methods: We report on three additional individuals who demonstrated that tract local recurrences may occur after a closed needle biopsy for nonosteosarcoma, nonextremity sarcomas. For perspective, the world literature is reviewed to identify tract recurrences for other malignancies and the results of needle biopsy in musculoskeletal neoplasms. Results: Eighty-nine percent of needle tract local recurrences occur when carcinomas are subjected to biopsy, as reported in the literature. Forty-seven cases since 1950 are described representing essentially all tumor types. The nature of musculoskeletal neoplasms makes closed biopsy more difficult than for softer, more homogeneous, and easier to access neoplasms. Conclusions: Local recurrences of sarcoma may occur in closed needle biopsy tracts. Strong consideration should be given to open biopsy and tract resection.     

子宫内膜活检在不孕症诊治中的评价(附1278例临床与病理分析)

本文报道了子宫内膜活检在诊治不孕症中的作用,并分析了1278例原发性不孕症患者子宫内膜活检后的临床诊断与病理学阳性的关系。其中无排卵性内膜85例占6.2％,黄体功能欠缺50例占3.9％,子宫内膜增生症21例占1.6％,子宫内膜炎8例占0.6％和内膜结核24例占1.8％。文中还对不孕的原因作了进一步的分析与讨论,提出了不孕症的诊治意见。     

Belt device for simplified CT-guided puncture and biopsy: A technical note

A new radiolucent device for increased accuracy of CT-guided fine-needle punctures permits precise determination of the optimum angle, depth, and position of the fine needle, which can be preset from the data supplied on the CT monitor. Puncture and repeat scans for controlling the tip of the needle can be performed with the patient in a stationary position. The device is designed as a belt that holds a needle holder sheath and a goniometric scale, both of which can be moved to varying positions around the patient.     

心脏移植术后急性排异反应的监测

目的 总结原位心脏移植术后急性排异反应的监测。方法 2000－01／2002－04施行11例原位心脏移植手术，结合临床表现、心电图、超声心动图、化验检查及心内膜活栓等检查，对心脏移植术后急性排异反应的监测进行分析。结果 采用临床症状＋心电图＋超声心电图＋心肌血清学检测综合判断有6次急性排异反应，行心内膜活检证实Ⅰb级2次，Ⅲa级3次；术后常规行心内膜活检21次，仅发现急性排异反应Ⅰa或Ⅰb级5次。结论 急性排异反应是关系到心脏移植术后患者康复及愈后的重要因素，因此要及时、有效地进行监测；心内膜心肌活检是诊断急性排异反应敏感可靠的方法，但为有创性检查，有一定的并发症风险，其他多项无创性检查可作辅助指标，因此急性排异反应监测应把无创性检查与心内膜心肌活检有机地结合起来。     

Radium-228 determination of natural waters via concentration on manganese dioxide and separation using Diphonix ion exchange resin

The objective of this work was to establish a new procedure for ²²⁸Ra determination of natural waters via preconcentration of radium on MnO₂ and separation of its daughter, ²²⁸Ac, using Diphonix ion exchange resin. Following removal of potential interferences via passage through an initial Diphonix Resin column, the first daughter of ²²⁸Ra, ²²⁸Ac, is isolated by chromatographic separation via a second Diphonix column. A holding time of >30 h for ²²⁸Ac ingrowth in between the two column separations ensures secular equilibrium. Barium-133 is used as a yield tracer. Actinium-228 is eluted from the second Diphonix Resin with 5 ml 1 M 1-Hydroxyethane-1,1-diphosphonic acid (HEDPA) and quantified by addition of scintillation cocktail and LSC counting. Radium (and ¹³³Ba) from the load and rinse solutions from the 2nd Diphonix column may be prepared for alpha spectrometry (for determination of ²²³Ra, ²²⁴Ra, and ²²⁶Ra) by BaSO₄ microprecipitation and filtration. Decontamination tests indicate that U, Th, and Ra series nuclides do not interfere with these measurements, although high contents of ⁹⁰Sr (⁹⁰Y) require additional treatment for accurate measurement of ²²⁸Ra. Addition of stable Sr as a “hold back” carrier during the initial MnO₂ preconcentration step was shown to remove most ⁹⁰Sr interference.     

A risk index for prostate cancer

BACKGROUND: The aim of the present study was to create a simple numerical index predicting the presence of prostate cancer in a group of high risk patients, for the purpose of selecting those most likely to need prostate biopsy. METHODS: 100 consecutive patients at high risk of having prostate cancer seen at Ramathibodi Hospital, Thailand between November 2000 and February 2002 were prospectively studied. All patients underwent transrectal prostate biopsies. The following predictor variables were obtained: age, digital rectal examination (DRE) findings, prostate specific antigen level, transrectal ultrasonography (TRUS) findings, and prostate volume determined by TRUS. The outcome was the presence of prostate cancer on histological examination of the biopsy specimens. A risk index for prostate cancer based on the linear predictor of a multiple logistic regression model was created. RESULTS: Almost all predictor variables were significantly related to the presence of prostate cancer. The final multiple logistic regression model with four categorized predictors (excluding DRE) was shown to have good discrimination, calibration, and cross-validity. For a cutoff risk index of 10, corresponding to a 10% probability of having prostate cancer, the sensitivity for detecting prostate cancer was 96.2%, with a specificity of 73.0%. Based on this cutoff, 55% of patients in this series might not require prostate biopsy. CONCLUSION: A risk index for prostate cancer was developed. If this index can be externally validated, the potential savings from avoiding unnecessary prostate biopsies, on the basis of selection using the index, could be significant.