前哨淋巴结显像研究

前哨淋巴结系指原发肿瘤淋巴引流的第一级淋巴结,淋巴显像可准确定位前哨淋巴结及其数目,检出率达80%~100%。常用的前哨淋巴结显像剂有99Tcm-硫胶体、99Tcm-人血清白蛋白、99Tcm-右旋糖酐等。该法简便安全、实用性强,已先后应用于黑色素瘤、乳腺癌、妇科肿瘤等疾病的术前常规定位诊断,取得了很好的结果。     

The impact of standardized care pathway on reporting time for invasive melanoma – results from one pathology department in Sweden

Abstract

Background: Standardized care pathway (SCP) was introduced by the Swedish health authorities to eliminate unwanted delay in the diagnostics of cancer patients; for melanoma, SCP started in 2016. The aim of this study was to investigate the impact of SCP on reporting time for invasive melanomas.

Materials and methods: Information on reporting time was collected on all samples handled according to the SCP and on all invasive melanomas diagnosed in 2016–2018 at the Department of Clinical Pathology, Akademiska University Hospital, Uppsala, Sweden.

Results: During the study period, 205 samples were handled according to the SCP, resulting in 53 cases (26%) diagnosed with invasive melanomas. A total of 301 invasive melanomas from 286 patients were diagnosed during the study period; 67 (22%) were submitted as SCP, 36 (12%) as a general priority case, and 198 (66%) as non-priority. The reporting time for the SCP cases was 8?days, for general priority cases 6?days, and for non-priority cases it was 24?days. The reporting time increased from 18 to 31?days for the non-priority cases and from 15 to 25?days for all cases with invasive melanomas during the study period.

Conclusion: This study demonstrates prolonged reporting times for invasive melanomas since the implementation of SCP. This is probably caused by the crowd-out effect of the SCP samples, limited personnel resources, and inaccuracy of the clinical diagnosis. SCP might therefore be a suboptimal method to shorten reporting times for invasive melanomas.     

老年妇女绝经后阴道流血的原因分析与治疗对策探讨

目的探讨分析老年妇女绝经后阴道流血的原因及治疗方案。方法回顾分析2007年1月-2011年12月我院接收的211例绝经后阴道流血及血性白带为主要症状的女性患者,排除因妊娠引起流血的病例,对其余患者进行妇科检查、经阴或腹部B超检查、TCT检查及宫腔镜下病理活检。观察分析所有患者的阴道流血的病因及病变程度。结果依据本组患者的各项检查及病理报告可分为：生殖器官炎症125例,子宫肌瘤18例,恶性肿瘤53例,其他15例。结论绝经早期阴道流血多数患者由生殖器官良性病变引起的,但随着绝经时间的延长,恶性程度越高,针对病因选取恰当的治疗方式才是行之有效的方案。     

脉络膜黑色素瘤的影像诊断与鉴别诊断

脉络膜黑色素瘤（choroidal melanoma,CM）是成人最常见的眼内恶性肿瘤,国内发病率仅次于发生在儿童的视网膜母细胞瘤,居眼内肿瘤的第二位.近年来随着计算机技术的飞速发展,影像学检查技术也日新月异,笔者就此进行相关性的文献查阅,分别从超声、CT、MRI、眼底造影、PET-CT等五个方面进行综述,旨在提高对本病的认识,提高诊断的符合率.     

The monoclonal antibody to cytotoxic T lymphocyte antigen 4, ipilimumab (MDX-010), a novel treatment strategy in cancer management

Background: Cytotoxic T lymphocyte antigen 4 (CTLA-4) is an inhibitory regulator of the T cell immune response against tumor cells. Ipilimumab (MDX-010) is a monoclonal antibody directed against CTLA-4. Objective: To describe the basic mechanism of ipilimumab and discuss data available to date with regards to its safety and efficacy profile. Methods: Data from clinical trials including abstracts were reviewed using the PubMed Database as well as the American Society of Clinical Oncology Abstract Database. Conclusions: CTLA-4 inhibition with a monoclonal antibody is usually well tolerated and has efficacy as a therapeutic agent in a variety of cancers. The most clinically important toxicities have been related to autoimmune events, and guidelines for treatment of these effects are now available. Preliminary results indicate that therapy with ipilimumab leads to durable responses. Pharmacokinetics and pharmacodynamics are different from those of traditional chemotherapy agents. Phase III studies are currently underway for melanoma.     

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提要：口腔黏膜原发恶性黑色素瘤是一种少见的恶性肿瘤,具有易复发、易转移、预后较差的特点。由于病例数稀少,临床及随访资料匮乏,并且缺少通行的黏膜恶性黑色素瘤分期分级标准。因此,对口腔黏膜原发恶性黑色素瘤还缺乏全面深入的认识。本文通过回顾相关文献,从流行病学、临床、病理、诊断和鉴别诊断以及分类等方面来概述口腔黏膜原发恶性黑色素瘤的特点。     

骨恶性纤维组织细胞瘤的影像表现

目的 探讨骨恶性纤维组织细胞瘤(MFH)的影像表现,以期提高对该病的认识和诊断水平. 资料与方法 回顾分析经病理证实的27例MFH的X线平片、CT及MRI的影像学特征. 结果 长骨20例:干骺端13例,其中股骨近端6例;骨干7例.扁骨或不规则骨7例.股骨近端病变以边界清楚的囊状骨质破坏为主.其他长骨干骺端的病变,以单纯的斑片状骨质破坏或骨质破坏区间夹杂粗细不等的骨嵴为主.骨干病变以虫蚀状、大块或膨胀性的骨质破坏为主.髂骨病变以大块溶骨性骨质破坏为主.坐骨病变以虫蚀状破坏为主,稍膨胀.MRI以长T1、长T2信号为主,其内信号不均匀,增强扫描病变呈不均匀强化. 结论 MFH影像表现多样,相同发病部位其表现也有相似之处.     

西宁地区恶性肿瘤患者的红细胞免疫功能研究

目的：研究西宁地区（海拔2260m）恶性肿瘤的红细胞免疫功能的相关内容。方法：按文献^[2]介绍采用郭峰建立的最常用的三种检测指标和方法。结果：肿瘤病人红细胞C3b受体花环R-C3bR、红细胞免疫粘附肿瘤细胞花环R-TRR低下，与健康人之间有显著性差别，红细胞免疫复合物IC花环R-ICR无统计学差别，肿瘤患者的R-TRR男女之间有显著性差别。各种肿瘤之间三种花环率无统计学差别。化疗前后三种花环率无统计学差别。肿瘤无转移与有转移三种花环率无统计学差别。手术前后三种花环率无统计学差别。结论：西宁地区恶性肿瘤病人的红细胞免疫功能R-C3bR、R-TRR低下，分别为13．4762±3．597，12．0543±5．6095，R-ICR为4.6131±3．4010，与健康人无统计学差别。