颅内混合性生殖细胞肿瘤的病理及形态学研究

目的探讨颅内混合性生殖细胞肿瘤（MGCT）的病理诊断和鉴别诊断要点.方法对4例颅内MGCT进行临床病理特点观察,使用OCT4、CD117、CD30、AFP、nestin等免疫组化染色辅助诊断.结果颅内MGCT可以由多种生殖细胞肿瘤成分组成,镜下病理形态多样.结论颅内MGCT的治疗和预后与病变包含的不同肿瘤成分有关,因此准确和完整的病理诊断十分重要,免疫组化有助于病理诊断.     

Stroke patients' experiences of sharing rooms with dementia patients in a nursing home

BACKGROUND: The mixed units that place lucid and dementia patients in same rooms have been viewed to benefit the dementia patients. However, many studies report negative attitudes of lucid residents towards mixed units, and there is a scarcity of research which explores the experiences of lucid residents while sharing rooms with the dementia patients in extended care homes. Currently many special care nursing facilities have mixed units in Korea, suggesting a need to examine their effects especially on cognitively lucid patients. OBJECTIVE: To explore lived experiences of stroke patients who were sharing rooms with patients with dementia in a nursing home. DESIGN: It was a qualitative study applying a phenomenological method to explore the experiences of stroke patients. SETTINGS: Data were collected in a specialized nursing home in Korea. The nursing home provides free medical and nursing care to persons suffering either from dementia or stroke. PARTICIPANTS: Fourteen participants without cognitive deficit and who were sharing rooms with dementia patients were recruited through a purposive sampling. METHOD: In-depth interviews RESULTS: Stroke patients sharing rooms with dementia patients were being seriously affected by intense, deeply disturbing, and persistent experiences. The experiences themselves seemed to evolve over time as each patient struggled on one's own to try to make sense out of what were happening. The stroke patients ended up having a sense of resignation and anger realizing that they had no power to change the policy or the situation. The stroke patients also were distraught about what were happening to themselves - change of their own character, continuous fear of becoming demented, and becoming to devalue life. They also became indifferent to others, and seemed to have lost motivation for activity resulting in a decreased or low activity level. Several personal and environmental factors were identified that tended to increase the level of suffering. We suggest that the whole concept of mixed units require further exploration, and there is a need for a comprehensive staff education program to help the staff become aware of the problems and provide support to patients. Orientation of stroke patients regarding dementia is also suggested.     

Nephropathy after administration of iso-osmolar and low-osmolar contrast media: Evidence from a network meta-analysis

Background/objectives

Contrast-induced nephropathy (CIN) may be a severe complication to the administration of iodine-based contrast media for diagnostic or interventional procedure using radiation exposure. Whether there is a difference in nephrotoxic potential between the various agents is uncertain. We aimed to perform a systematic review and network meta-analysis of randomized trials on iodine-based contrast agents.

Methods

Randomized trials of low-osmolar or iso-osmolar contrast media were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus. Risk of CIN was appraised within a hierarchical Bayesian model computing absolute rates (AR) and odds ratios (OR) with 95% credibility intervals, and probability of being best (Pbest) for each agent.

Results

A total of 42 trials (10048 patients) were included focusing on 7 different iodine-based contrast media. Risk of CIN was similarly low with iodixanol (AR = 5.7% [2.2%–13.9%], Pbest = 18.8%), iomeprol (AR = 6.0% [2.2%–15.4%], Pbest = 24.8%), iopamidol (AR = 6.1% [2.2%–15.5%], Pbest = 21.5%), and ioversol (AR = 6.0% [2.1%–16.4%], Pbest = 31.3%). Conversely, CIN was twice as common with iohexol (AR = 11.2% [4.1%–29.5%], Pbest = 0.1%) and ioxaglate (AR = 11.0% [4.0%–26.9%], Pbest < 0.1%), with both proving less safe than iodixanol (respectively OR = 2.18 [1.22–3.92] and 2.05 [1.26–3.29]), iomeprol (OR = 2.08 [1.04–4.17] and 1.96 [1.06–3.48]) and iopamidol (OR = 2.04 [1.15–3.85] and 1.92 [1.06–3.45]). Data on iopromide were less conclusive (AR = 6.9% [2.6%–17.1%], Pbest = 3.6%).

Conclusions

Iodixanol, iomeprol, iopamidol and ioversol are iodine-based contrast media with a similar renal safety profile. Iohexol and ioxaglate have a poorer renal safety profile, whereas further data may be required on iopromide.     

乳头状胶质神经元肿瘤临床病理分析

目的　报道 2例罕见的乳头状胶质神经元肿瘤 (PGNT) ,结合文献探讨其临床病理学特征。方法　对 2例PGNT进行临床病理分析及免疫组化观察。结果　 2例均为青年患者 ,临床表现为发作性头痛或慢性难治性癫 ,神经系统检查均无局灶性定位体征 ,MRI检查见颞叶脑实质内有边缘清晰的囊性病灶 ,囊壁内附有实性结节。镜下见肿瘤由神经元和胶质成分混合构成 ,并呈特征性的乳头结构 ,乳头中心为透明样变的血管 ,乳头表面为单层GFAP阳性的胶质细胞 ,另见乳头之间或成片排列的小圆形Syn阳性的神经元分化的细胞 ,散在有神经节样细胞和 或神经节细胞 ,未见坏死和核分裂象。结论　PGNT是一种新的独特的神经元 -胶质混合性肿瘤 ,预后良好     

冰敷预防痔切除术后尿潴留的临床研究

目的寻求一种有效的预防痔疮术后尿潴留的护理方法,减少痔切除术后并发症的发生,减轻病人的痛苦。方法将200例混合痔的住院患者随机分为两组。治疗组术后立即用肛门模型冰块加压包扎敷于肛门术口大敷料外,对照组只用敷料而不作冰敷。结果治疗组尿潴留发生率明显低于对照组,两组比较差异有显著意义(P<0.01)。结论痔切除术后进行肛门冰敷可预防尿潴留的发生。     

克痔消炎止血膏治疗嵌顿痔的临床观察及护理

目的 探讨克痔消炎止血膏外敷治疗嵌顿痔局部症状的疗效及护理方法.方法 将143例嵌顿痔患者分成观察组73例和对照组70例,观察组采用自制的克痔消炎止血膏外敷,对照组使用传统马应龙麝香痔疮膏外敷,进行疗效对比观察.结果 观察组痊愈46人,好转26人,有效率98.4%,平均治愈时间和好转时间分别为(4.19±1.29)d和(1.53±0.81)d;对照组痊愈35人,好转25人,有效率85.71%,平均治愈时间和好转时间分别为(8.62±1.50)d和(5.45±1.15)d.经χ2检验和t检验,2组治疗结果和治愈好转时间均存在显著性差异.结论 克痔消炎止血膏用于治疗嵌顿痔所引起的局部症状疗效优于马应龙麝香痔疮膏,护理上注意调敷药膏的温、湿度适中,指导患者正确进食.     

动物致伤人群接种狂犬病疫苗后血清学与流行病学效果的初步分析

目的观察就诊的动物致伤者,分别全程足量接种两种剂型狂犬病疫苗后,其血清中抗体阳转率和疫苗保护率。方法2000—2001年就诊者全程接种浓缩苗,2002—2003年的全程接种精制纯化(vero细胞)苗。严重致伤者,于0、3天接种加倍量疫苗,并于0天的同时,对其伤口周围用抗狂犬病血清(40IU/kg)进行浸润注射。联合使用抗血清者,完成全程5次注射后第15、75天各加强1针疫苗。接种结束后15—20天,以间接混合酶标法检测血清中抗狂犬病病毒抗体。期内经疫情报告系统,收集当年观察人群狂犬病病例,计算两接种组人群的发病率,并分别与当年未接种疫苗的动物致伤人群比较,以估算疫苗保护率。结果4年中该人群抗体总阳性率为95.60%。接种精制纯化苗组的阳性率为96.37%,高于浓缩苗组的94.83%。狂犬病疫苗保护率,精制苗1年和2年的均为100.00%;浓缩苗1年的为95.46%,2年、3年和4年的为90.91%。结论动物致伤人群规范处理局部伤口后,及时全程接种狂犬病疫苗,其抗体阳性率较高。国产精制纯化苗接种人群的抗体阳性率和1~2年的疫苗保护率高于浓缩苗。从我国狂犬病防治工作实际出发,提示国产精制纯化苗需尽快降低成本,以巩固和提高其接种率。     

微波组织凝固治疗痔的实验及临床观察

采用微波组织凝固治疗痔的实验证明，针状辐射器刺入动物的胆管粘膜可获得表浅的组织变性坏死，血管栓塞。１８２例痔患者经微波组织凝固治疗后，疼痛较轻，愈合过程平稳。１６６例随访平均２０．８个月，疗效满意，无远期并发症。微波组织凝固的方法简单安全，仪器价廉，体积小适于搬动，有利于基层卫生机构推广开展。     

Predominance of type 1 (Th1) cytokine production in the liver of patients with HCV-associated mixed cryoglobulinemia vasculitis

BACKGROUND/AIMS: Patients with hepatitis C virus (HCV) mixed cryoglobulinemia (MC) vasculitis have a higher mortality rate and more frequent incidence of cirrhosis than their cryoglobulin-negative counterparts. To compare the cytokine profile of liver-infiltrating T cells in HCV-infected patients with or without MC vasculitis. METHODS: Hepatic biopsy specimens were obtained from HCV infected patients with and without MC vasculitis. Using intracellular staining and flow cytometry, we assessed the ability of freshly isolated liver T cells from these biopsies to produce IFN-gamma, TNF-alpha, IL-2, IL-4, and IL-10 in response to stimulation with PMA and ionomycin. RESULTS: HCV-MC vasculitis patients compared to HCV-MC negative controls have an enhanced hepatic T cells production of Th1-type cytokines [i.e. TNF-alpha(30.3 +/- 13% vs. 15.5 +/- 5%, P = 0.01), IL-2 (20.2 +/- 9% vs. 10 +/- 4%, P = 0.01) and IFN-gamma (22.2 +/- 11% vs. 9.4 +/- 4%, P = 0.008)], whereas IL-10, a representative Th2-type cytokine, was significantly lower (7.2 +/- 4% vs. 17 +/- 7%, P = 0.01). CONCLUSIONS: T cell from the liver of HCV-MC vasculitis patients display a significantly augmented liver Th1 profile compared to MC-negative controls. This enhanced production of type-1 cytokines may account for a more severe course of liver disease.     

四例结直肠少见类型的混合性腺神经内分泌癌（MANEC）病例报道

混合性腺神经内分泌癌（MANEC）是一类罕见肿瘤,由至少各占30%的腺癌和神经内分泌肿瘤组成。本文报道了4例少见类型的结直肠MANEC,其中一例由低级别神经内分泌肿瘤（G1）和高分化管状腺癌组成,另外三例由高级别神经内分泌肿瘤（G3）和中——低分化腺癌组成。从以上病例总结中发现,MANEC的神经内分泌肿瘤成分具有更强的侵袭力和淋巴结转移率,所以目前MANEC的分级应该根据不同肿瘤成分进行更加细化的分类。