甲状腺乳头状癌颈部淋巴结转移特点及清扫策略

背景与目的：目前,在甲状腺癌颈淋巴结清扫方面存有较大分歧。该研究总结甲状腺乳头状癌淋巴结转移的特点,为择区淋巴结清扫提供理论依据。方法：回顾性分析2006年7月—2014年8月收治的462例甲状腺乳头状癌患者病历资料,分析其淋巴结转移规律及其影响因素,评判cN0标准的准确性。结果：全组患者均行患侧中央区(Ⅵ区)淋巴结清扫,320例行侧颈区淋巴结清扫术(Ⅱ～Ⅴ区)或择区淋巴结清扫(Ⅱ～Ⅳ区中的部分或全部),90例行对侧中央区淋巴结活检。73.2%(338/462)符合cN0标准,病理证实其中有184例淋巴结转移,cN0标准误诊率达60.9%。颈部淋巴结总转移率为65.4%(302/462),侧颈区淋巴结转移率为42.6%(197/462),“跳跃转移”率为13.1%(42/320),对侧中央区淋巴结转移率为50%(45/90)。男性、肿瘤累及腺叶上1/3、肿瘤T3或T4、多中心病灶是淋巴结转移的危险因素。肿瘤累及腺叶上1/3是喉前淋巴结转移及“跳跃转移”的危险因素。喉前淋巴结转移及中央区淋巴结2个以上转移者侧颈区淋巴结转移率显著增加(分别为85.7%和83.3%, P＜0.05)。结论：现行cN0标准不能作为确定淋巴结清扫范围的依据;甲状腺乳头状癌易发生淋巴结转移,其中Ⅵ区淋巴结转移率最高,依次为Ⅲ区、Ⅱ区、Ⅳ区、Ⅴ区;初次手术应常规清扫患侧中央区淋巴结,建议将Ⅵ区淋巴结送冰冻病理;当喉前淋巴结有转移或Ⅵ区2个以上淋巴结转移时,或肿瘤累及腺叶上1/3者,有必要行侧颈区(或择区)淋巴结清扫;对侧中央区淋巴结转移率较高,需予以重视;中央区淋巴结再分亚区具有重要意义,应深入研究。     

A double-blind study of the influences of eszopiclone on dysgeusia and taste function

Taste disturbance is a common, but poorly understood, side effect of a large number of medications. This double-blind study examined the frequency, intensity, and quality of taste disturbances related to the widely used hypnotic sleep aid eszopiclone (ESZ; Lunesta^®), as well as their associations with age, sex, body mass index (BMI), time of day, phenyl thiocarbamide (PTC) taste sensitivity, and ESZ saliva and blood levels. Sixty six percent of 24 female subjects and 53% of 15 male subjects reported dysgeusic sensations, mostly bitter/metallic, during the drug administration (respective placebo figures 17% and 7%). No meaningful relationships were found between the frequency or the intensity of the sensations and age, BMI, or PTC taste sensitivity. Dysgeusia was more intense and longer lasting in women than in men, stronger in the morning than in the evening, and positively correlated with drug plasma and saliva levels. In women, intensity ratings decreased across treatment days. Taste test measures were marginally, at best, influenced by ESZ. This study demonstrates, for the first time, that the dysgeusia associated with ESZ is systemically influenced by a number of factors, including sex, time since drug administration, and both blood and saliva levels of the drug.     

Persistent fetal circulation: An evolving clinical and radiographic concept of pulmonary hypertension of the newborn

The roentgenographic presentations of 11 newborn infants with hypoxemia secondary to pulmonary vasospasm and subsequent right-to-left shunting of blood through the foramen ovale and/or ductus arteriosus (persistent fetal circulation) are described (P. F. C. Syndrome). One infant had radiographically normal lungs, while ten had pulmonary parenchymal abnormalities including hyaline membrane disease [4], meconium aspiration syndrome [4], or an ill defined pattern of retained lung fluid [2]. The roentgenographic appearance of the lungs, however, was discordant with the severe hypoxemia observed in most. Heart size was variable but some degree of cardiomegaly was commonly present. Tolazoline, a potent vasodilator, was useful diagnostically and may have resulted in increased survival. An expanded clinical and roentgenographic concept of the PFC syndrome is suggested.Presented in part at The Annual Meeting of the Society for Pediatric Radiology, Atlanta, Georgia, September, 1975, and at the 13th Meeting of the European Society of Pediatric Radiology, Stockholm, Sweden, May 21, 1976     

Evaluation of acute trismus by MRI: a case report

We describe a rare case of a bilateral peritonsillar cellulites (PTC). The clinical presentation of fever, trismus and odynophagia was consistent with PTC, more evident on the right side; but the presence of bilateral tonsillar swelling and midline uvula confounded the diagnosis. In spite of the throat examination was performed with a great difficulty due to trismus, the T2 weighted fat saturated STIR magnetic resonance imaging (MRI) guided us to make the diagnosis and to start the intravenous antibiotic treatment immediately.     

A nonsense mutation in exon 3 results in the HLA-B null allele B*5127N

A new HLA-B null allele has been identified within the B*51 group by combined serological and molecular typing of an Italian Caucasoid family. Serological data indicated that the proband typed homozygous for A2 and B60. Confirmatory typing using sequence specific oligonucleotide hybridization (SSPOH) detected a second B allele within the B*51 group. Allele specific typing (SSP) for B*51 subtypes, including the known B*5111N allele, was performed, and typing results were consistent with B*5101, suggesting the presence of a new null variant. Cloning and sequencing of this allele identified a B*5101 variant with a nonsense mutation in exon 3. This new null allele has been designated B*5127N. The combined use of serologic and DNA-based typing methods facilitates the identification of null and low-expression alleles. An overview of null alleles of class I HLA is presented.     

直接胆管造影时胆囊不显影的意义探讨

本文回顾性分析连续130例(ERCP 78例、PTC 52例)肝内外胆管显影好、技术上满意、未作胆囊切除而胆囊或胆囊管不显影的直接胆管造影片及手术结果。按使胆囊不显影病变的部位将所有病例分成3组:(1)胆囊和/或胆囊管病变(83例,63.8％):(2)胆总管中下段病变(37例,28.5％);(3)肝总管远端或胆总管近端病变(9例,6.9％)。分析胆囊和/或胆囊管不显影的原因及发病机制。 本研究证明:直接胆管造影中,(1)如果肝内外胆管显影好且无梗阻性病变,胆囊和/或胆囊管不显影可下“病理胆囊”的诊断;(2)如果肝内外胆管显影好,胆总管或肝总管远端有梗阻性病变,胆囊和/或胆囊管不显影不一定提示胆囊或胆囊管病变。     

姜黄素和芦荟胶冻干粉及PTC的抗放射作用研究

〔目的〕 通过对受γ射线外照射小鼠骨髓、小肠和睾丸形态、肝组织化学发光、外周血象的改变,比较姜黄素、芦荟胶冻干粉和ＰＴＣ三种药物的抗放射线效果,并探讨其作用机理。〔方法〕 放射源为＾６０Ｃｏ,剂量率１４６．２０ｃＧｙ／ｍｉｎ,哈身照射２００ｃＧｙ。照后６ｈ眼球取血,测外周血象;活杀小鼠取肝脏制匀浆,做化学发光测定;取股骨、小肠和睾丸固定于甲醛溶液、包埋、切片行ＨＥ染色,在光学显微镜下计数凋亡细胞。〔结果〕 （１）外周血淋巴细胞绝对值姜黄素组、ＰＴＣ组显著高于照射对照组（Ｐ〈０．０５）,白细胞各组间无显著差异;（２０化学发光值测定显示,姜黄素组、姜黄素组、ＰＴＣ组显著高于照射对照组（Ｐ〈０．０５）;（３）姜黄素组、ＰＴＣ组和芦荟组小鼠骨髓、小肠和睾丸凋亡细胞数明显低于照射对照组（Ｐ〈０．０１）。〔结论〕 三种药物     

PTC与PTBD在恶性梗阻性黄疸诊断治疗上的应用

本文报告对肿瘤性黄疸病人行PTC86例,PTBD30例的临床体会。指出PTC方法简单、成功率高、合并症少。PTBD治疗梗阻黄疸作用分为术前减黄和姑息外引流两方面。尤其是不需X线设备,床旁体表定位下的PTBD17例,15例成功,更为简便、合并症少,对梗阻性黄疸有治疗价值。作者建议,对肿瘤性黄疸病人采用以下诊治步骤:B超→ERCP→床旁PTBD→经管造影,决定治疗方案为进一步手术治疗或永久带管外引流,提供有力依据。