高危型人乳头瘤病毒检测在宫颈环形电切治疗中的意义

目的:研究高危型人乳头瘤病毒(HR-HPV)对非典型鳞状细胞(ASC)或低度鳞状上皮内病变(LSIL)患者进行宫颈环形电切(LEEP)治疗的辅助诊断价值。方法:回顾性分析186例ASC或LSIL患者的HR-HPV检测、阴道镜下活检病理和LEEP病理结果,比较HR-HPV阳性和阴性患者中高级别病变(CIN2+)的发生率。结果:ASCUS、ASC-H和SLIL患者中HR-HPV的阳性率分别为67.1%、75.0%和89.3%,活检病理结果为CIN2+的比例分别为13.4%、60.0%和32.1%,而LEEP病理结果为CIN2+的比例分别为19.5%4、5.0%和33.3%。最终病理结果为CIN2+的患者在HR-HPV阳性患者中的比例为37.9%,而在HR-HPV阴性患者中的比例为17.0%,差异具有显著性(χ2=5.873,P=0.015)。结论:细胞学结果为低级别病变的患者中存在较高比例的高级别病变患者,检测HR-HPV有助于及时发现高级别病变患者。     

Recurrent low-grade glioma in children with special reference to computed tomography findings and pathological changes

Recurrent low-grade gliomas in children were studied with special reference to correlation between the computed tomography (CT) scan and pathological findings at recurrence. During the past 16 years (1970–1986) 105 cases of primary pediatric brain tumors were treated in our hospital. Seventeen of these had low-grade glioma, seven of which (five astrocytomas, one ependymoma, and one subependymoma) had recurrence of tumor by the end of 1987. The enhanced CT findings were classified into three types — cystic, false cystic, and solid, according to Lapras' classification. The pathological findings of recurrent tumors were reviewed with particular attention to malignant transformation. The results showed that in two out of three cases where CT findings had changed from initial cystic to solid type at recurrence malignant transformation was revealed. Enhanced CT scan was also useful for detecting small asymptomatic recurrent tumors in children. On the other hand, surgical procedures and adjuvant therapies demonstrated no significant relationship with recurrence. It is suggested that the recurrence of low-grade glioma in children is not rare, and that changes in findings on contrast enhanced CT might reflect malignant transformation in a recurrent tumor, necessitating a careful follow-up.     

Abdominal Cocoon: Clinical Presentation, Diagnosis, and Management

A 15-year-old girl presented with features suggestive of sub-acute intestinal obstruction (SAIO) with a palpable abdominal lump. Contrast-enhanced computed tomogram (CECT) abdomen revealed congregated small gut loops confined to a single area and encased in a thick membrane suggestive of abdominal cocoon. On laparotomy, a thick white membrane was found encasing most of the small gut. The cocoon was excised releasing the encased small bowel. The patient was relieved of her symptoms following surgery. Histopathology of excised cocoon membrane revealed granulomatous inflammation consistent with tuberculosis. The patient was discharged on ninth postoperative day with advice to take anti-tuberculosis drugs for 6 months. The possibility of abdominal cocoon should be considered in patients with SAIO and abdominal lump. Abdominal cocoon being a rare condition, CECT is useful in clinching the diagnosis and planning elective surgery in experienced hands.     

Radio-induced low-grade glioma: report of two cases and review of the literature

With the increasing number of cancer survivors, we can observe a population that will present a higher risk of developing secondary long-term toxicities related to adjuvant chemo and radiotherapy regimens. Among these, children surviving from acute lymphoblastic leukemia (ALL) that were treated with prophylactic cranial irradiation represent a group of patients at a high risk of developing secondary brain tumors. Radiation-induced intracranial tumors have been documented since 1950, and today, more than one-hundred cases have been described. We report our experience with two young patients who were hospitalized for low grade gliomas and had a positive anamnesis for ALL and consequent radiotherapy.     

Regions, systems, and the brain: hierarchical measures of functional integration in fMRI

In neuroscience, the notion has emerged that the brain abides by two principles: segregation and integration. Segregation into functionally specialized systems and integration of information flow across systems are basic principles that are thought to shape the functional architecture of the brain. A measure called integration, originating from information theory and derived from mutual information, has been proposed to characterize the global integrative state of a network. In this paper, we show that integration can be applied in a hierarchical fashion to quantify functional interactions between compound systems, each system being composed of several regions. We apply this method to fMRI datasets from patients with low-grade glioma and show how it can efficiently extract information related to both intra- and interhemispheric reorganization induced by lesional brain plasticity.     

Hemorrhagic presentation of previously silent brain tumors

Introduction and objectivesAcute presentation with intracranial hemorrhage owing to a previously silent brain tumor (BT) is rare. Although any BT can bleed, the frequency and type of bleeding varies across tumor types.Materials and methodsWe aimed to retrospectively review our experience with 55 patients with BTs presenting with ICH.ResultsSigns of increased intracranial pressure were the most common symptoms. The temporal lobe was the most common lesion site (n = 22). Hemorrhages were mainly confined to the tumor margins (HCTs) (n = 34). Extensive intraparenchymal hemorrhages (EIHs) were mainly associated with moderately/severely decreased levels of consciousness (LOCs) (n = 15/16). High-grade glioma (HGGT) (n = 25) was the leading pathological diagnosis followed by metastasis (MBT) (n = 16/55). The hemorrhage type was associated with the pathological diagnosis of the tumor. Patients with HGGT (n = 19/25) and MBT (n = 9/16) mainly presented with HCTs, whereas low-grade gliomas (LGGT) primarily caused EIHs (n = 6/7).ConclusionsHemorrhagic presentation is a rare occurrence in BTs. Among all, MBT and HGGT are responsible for majority of the cases. Importantly, despite their relatively benign characteristics, LGGTs mainly result in extensive parenchymal destruction once they bleed. Maximum surgical resection of hemorrhagic BTs and decompression of the affected brain regions followed by histological confirmation of the diagnosis should be the main goals of treatment in cases with hemorrhagic BTs.     

食物不良反应与2型糖尿病的关系-178例2型糖尿病患者问卷调查

目的假设2型糖尿病的发病在很大程度上与食物的免疫原性相关,因此对2型糖尿病患者食物不良反应进行初步调查,探讨食物的免疫原性以及食物损伤与糖尿病发病的相关性。方法对确诊的178例2型糖尿病人使用统一调查表进行自填问卷调查,内容包括基本资料、过敏症状、可疑过敏食物、转归。结果大部分患者存在多种食物不良反应。结论食物的免疫损伤应该作为2型糖尿病的独立风险之一受到关注,避免致敏食物的摄入应成为防治2型糖尿病的手段之一。     

Metastatic low-grade endometrial stromal sarcoma with variable morphologies in the ovaries and mesentery: A case report

BACKGROUNDLow-grade endometrial stromal sarcoma (LGESS) classically exhibits a proliferative morphology. However, morphological variation of extrauterine tumors presents a diagnostic challenge.CASE SUMMARYWe report the case of a 76-year-old female patient with extensive extrauterine and abdominal neoplastic lesions. Computed tomography showed massive pleural and ascitic fluid, and there was an increase in serum cancer antigen 125. She underwent bilateral adnexectomy and tumor resection. The right ovary had been replaced by a multinodular mass that was 8.5 cm × 4.5 cm × 3.5 cm in size. In addition, there was a 24 cm × 15 cm × 13 cm mesenteric mass, which was also multinodular, with local invasion of the intestinal serosa and underlying muscle. Under the microscope, the tumors in different places exhibited two different patterns, thus presenting great challenges to diagnosis and treatment. Thorough pathological assessment eliminated all differential diagnoses in favor of metastatic LGESS derived from a 20-year-old primary tumor initially misdiagnosed as leiomyosarcoma. CONCLUSIONLGESS morphology varies according to tumor location. Accurate diagnosis is critical for appropriate treatment and improved prognosis and patient care.