骨肿瘤经皮套管针穿刺活检

[目的]报告171例穿刺活检的结果并探讨相关影响因素。[方法]采用套管活检针对骨肿瘤进行术前穿刺活检，回顾分析171例骨肿瘤患者的穿刺活检的结果。[结果]171例，穿刺活检阳性155例，穿刺活检阳性率90．64％，行手术治疗获得大体标本病理诊断者122例，活检准确诊断者98例，准确率80．33％，误诊5例。恶性肿瘤总例数110例，穿刺活检敏感性95．41％，特异性100％。[结论]穿刺活检对骨肿瘤术前诊断有较大价值，实施者对骨肿瘤的认识水平，操作的细致程度，对活检阳性率、准确率及并发症的发生有重要影响。     

Age estimation in biopsy specimens of dentin

Determination of age at death on the basis of aspartic acid racemization in dentin is one of the most reproducible and accurate methods. In Germany, age estimation by this method has so far generally not been applied to living persons, since the extraction of a tooth exclusively for age estimation when it is not medically indicated is regarded as ethically and legally problematic. The development of a biopsy technique applicable to dentin took place against this background. Testing the technique and analysis of dentinal biopsy specimens revealed that the biopsy technique is a low-risk procedure that causes only minor discomfort to the affected person. It is readily practicable and facilitates standardized specimen removal. The relationship between the extent of aspartic acid racemization in dentinal biopsy specimens and age is very close, facilitating age estimation. A prerequisite for accurate results is the performance of biopsies under strictly standardized conditions. If this is guaranteed, age determination on the basis of aspartic acid racemization in dentinal biopsy specimens appears to be superior in precision to most other methods in living persons and can be used for all age groups.     

Proximal myotonic myopathy

Three Swedish patients with proximal muscle weakness, myotonia and lack of CTG expansion on genetical analysis are presented. Clinical neurological and neurophysiological examination and muscle biopsy were performed. There was an indication of autosomal dominant inheritance in 2 of the 3 patients. The main symptoms and clinical findings in the 3 patients were weakness of the proximal muscles, myotonia, muscle stiffness, muscle pain and muscle atrophy. Neurophysiological examination showed myotonic bursts and muscle biopsy snowed a variation of fibre sizes, an increased number of muscle fibres with centralized nuclei and scattered atrophic muscle fibres. Laboratory data showed elevated CK, GT and LD in 1 patient. Before genetical analysis was performed, all 3 patients had been diagnosed as atypical cases of myotonic dystrophy. However, the symptoms, clinical signs, laboratory data, electrophysiological and muscle biopsy findings were compatible with proximal myotonic myopathy (PROMM).     

细针吸取活检在乳腺增生诊断中的作用

本文对我科于1986年元月～8月收治的100例乳腺增生病人的临床诊断进行了研究。100例病人全部做了细针吸取活检及细胞学检查,轻度增生71例,中度增生13例,重度增生16例。细针吸取活检简单、方便,是乳腺增生症诊断的一种重要方法。     

胸膜活检阳性率的主要相关因素

分析了92例胸膜活检资料,认为其阳性率与下述因素有关:疾病种类、病例选择、活检器械、取材方法及技术、重复检查、临床医师与病理医师的配合。     

Diagnostic value of stereotactic biopsy of cerebral lesions in patients with AIDS

Summary A neurological complication occurs in 40–60% of HIV infected patients during the course of the disease. In 10–20% the neurological complication is the first manifestation of the HIV infection. A reliable neuropathological diagnosis is a prerequisite for a specifically selected treatment. While modern computer-assisted imaging techniques, such as computed tomography or magnetic resonance imaging, do possess a high sensitivity, they do not as a rule permit an unambiguous diagnosis.Between October 1989 and July 1994 we biopsied 38 HIV infected patients stereotactically. The indication for the biopsy was determined by having radiologically detectable lesions with no regression tendency in patients under antitoxoplasmosis therapy. In 89% an unambiguous diagnosis wa made based on the biopsy; 11 % of the biopsies were not diagnostic. For the most part, toxoplasmosis (31%) and progressive multifocal leucoencephalopathy (29%) were involved. 18% of the patients suffered from a non-Hodgkin lymphoma. The foci were primarily frontal (47%), parietal (21%) or localised in the basal ganglia area (11%). The result of the biopsy led to a change in treatment for 52% of the patients. Morbidity and mortality of the operation were 0%.The results or our research series are similar to other groups. It was shown that stereotactic brain biopsy is a safe and effective method for establishing a sound basis for treating the frequently life-threatening cerebral complications of AIDS.     

鱼腥草止咳口服液治疗难治性肺炎的临床观察

目的:观察鱼腥草止咳口服液对难治性肺炎患者的临床疗效,并探讨其作用机理。方法:65例患者随机分成两组,治疗组35例,对照组30例。对照组采用西医常规治疗,治疗组在同对照组治疗基础上加用鱼腥草止咳口服液口服,观察两组患者症状及体征的改善情况,并检测治疗前后外周血IL-2和TNF-α的变化。结果:治疗后总有效率:治疗组为94.3%,对照组为83.3%,组间比较有显著性差异(P<0.05);治疗组在增加外周血IL-2及降低TNF-α水平方面明显优于对照组。结论:鱼腥草止咳口服液治疗难治性肺炎具有显著疗效,尤其在镇咳、平喘、抗炎、退热及促进排痰、肺部啰音和炎症消失、毒副作用等方面具有明显优势。     

Stereotactic brain biopsy in AIDS

Summary In the hope of finding a treatable condition, the need for rapid diagnosis in HIV-seropositive patients with brain lesions is apparent. In order to evaluate the efficacy of stereotactic brain biopsy in AIDS patients, we retrospectively studied 25 HIV-infected patients undergoing stereotactic biopsy. Brain lesions were identified with gadolinium-enhanced MRI and/or contrastCT. Brain biopsy was performed using the system of Riechert. From 8 up to 15 small tissue samples from one or two targets were obtained in every patient. The biopsy material was examined cytologically, histologically (including electron microscopy), immunohistochemically and, in part, by animal test and polymerase chain reaction (PCR). A definite diagnosis was achieved in 92%. Diagnosis included primary central nervous system lymphoma (PCNSL) (10), toxoplasmosis (10), progressive multifocal leukoencephalopathy (2) and one case of co-existing toxoplasmosis and cytomegalovirus infection. Two biopsies were non-diagnostic. All PCNSLs showed polymorphic B-cell populations of high malignancy; accurate classification according to the Kiel classification was not possible. In 3 lymphomas Epstein-Barr nuclear antigen (EBNA) 2-mRNA could be detected by PCR and confirmed immunohistochemically by EBNA 2 expression. In 6 cases autopsy confirmed the biopsy diagnosis. Conventional histology was not sufficiently decisive for toxoplasmosis and progressive multifocal leukoencephalopathy, so that immunohistochemistry and animal tests became very important for a final diagnosis. With the help of different morphological and molecular biological techniques stereotactic brain biopsy appears to be an effective method in the diagnosis of HIV-associated brain lesions. In view of the marked radio- and chemosensitivity of PCNSLs it is mandatory to establish an early and accurate histological diagnosis for adequate treatment.     

Protein-loading test, urinary albumin excretion and renal morphology in diagnosis of subclinical diabetic nephropathy.

The acute effects of protein loading (1.5 g kg-1) on glomerular filtration rate (GFR) and urinary albumin excretion (UAE) were investigated in 23 type-I diabetic patients with no clinical nephropathy, and in 7 healthy subjects (controls). The results were compared with renal morphology data. In controls and in 14 diabetic patients (group 1) GFR increased by 27 and 37%, respectively, corresponding to normal renal reserve, but in 9 patients (group 2) GFR decreased by 20%, indicating the absence of a renal reserve. Microalbuminuria was found in none of the patients in group 1 and in 50% of patients in group 2. Two hours after the load UAE increased in all groups, but the increase was most marked in group 2, despite the fall in GFR. The two groups of patients did not differ with regard to the duration and control of diabetes, but differed markedly in terms of baseline GFR (131 vs. 195 ml min-1, P less than 0.01, in groups 1 and 2, respectively). Renal morphology showed minimal non-specific glomerular injury in group 1, and signs of glomerulosclerosis in group 2. We conclude that the impaired renal response to protein load precedes other subclinical manifestations of diabetic renal injury, and may be useful in the diagnosis of latent diabetic nephropathy.     

移植肾彩色多普勒血流超声与肾穿刺活检的对照研究

将彩色多普勒血流超声与移植肾活检结果相对照。评价无创性ＣＤＦＩ对移植肾排异反应的诊断价值。结果：不同病理状态下移植肾的阻力指数有所不同。急性排异和慢性排异反应组的ＲＩ值明显高于正常组。两次肾活检提示由急性排异转为慢性排异反应的同一患者，ＣＤＦＩ的动态观察显示，ＲＩ值明显增高。