神经源性声带运动障碍与喉神经电生理

声带运动障碍的病因和临床表现复杂多变，涉及多学科，从病因上分为神经源性和非神经源性。对于神经源性声带运动障碍的诊治，首先通过喉镜等检查明确有无声带运动障碍及严重程度，值得注意的是声带纵向张力变化障碍也属于运动障碍的范畴；然后采用喉肌电图（LEMG）检查进行定性分析，在确诊神经源性损伤后，进一步对神经损伤部位进行定位诊断并查找导致神经损伤的病因；同时根据喉部神经电生理评估结果，判断预后。最后综合上述的评估结果制定相应的治疗策略。     

Duodenal lymphangitis carcinomatosa: Endoscopic characteristics and clinical significance

Background and Aim: Duodenal lymphangitis carcinomatosa has been sporadically described, but so far little attention has been paid to duodenal lymphangitis carcinomatosa. Methods: Four cases with duodenal lymphangitis carcinomatosa were endoscopically and histologically examined. Results: The four cases exhibited multiple polypoid lesions along the Kerckring's folds and/or were covered by characteristically granular, non‐ulcerated mucosa upon thickening. The granularity seems to been caused by dilated lymph vessels containing the carcinoma cells. The lesions were microscopically characterized by: (i) involvement of lymph vessels located in the upper portion of the lamina propria; (ii) no inflammatory changes; and (iii) no desmoplastic changes. Primary sites were thought to be the stomach in case 1, the pancreas in cases 2 and 4, and unknown in case 3. All patients died within 6 months after admission or endoscopic examination. Conclusions: As duodenal lymphangitis carcinomatosis shows characteristic endoscopic appearance, endoscopic diagnosis is not difficult. We should realize that the lesion represents extremely poor prognosis, and it should be distinguished from ordinary metastatic duodenal carcinoma.     

Follow up of patients with colorectal polyps: are the BSG guidelines being adhered to?

OBJECTIVE: The publication of the BSG guidelines in 2002 provided a framework for the follow up of patients with colorectal polyps. The aim of the present study was to determine whether they had, or were being correctly adhered to in a moderately sized District General Hospital. METHOD: A total of 598 patients were on the waiting list for colonoscopy at Airedale General Hospital (AGH) in February 2005. Of these, 203 were being followed up as a result of the previous finding of a polyp. RESULTS: Only 14.8% of patients had been or were being followed up according to the BSG guidelines. The majority of the 85.2% of patients who did not comply with follow up did so as a result of over investigation. Seventy-eight per cent of the low-risk group and 55% of the intermediate-risk group had been colonoscoped, or were waiting to have colonoscopy, too soon or too frequently according to the BSG guidelines. Twenty-four patients with hyperplastic polyps were being followed up incorrectly, as were 17 patients discovered to have a polyp pathology on flexible sigmoidoscopy. It was established that 131 extra colonoscopies had been, or were planned to be performed unnecessarily. CONCLUSION: These data have major implications with regard to patient safety, service provision and cost to the NHS.     

Transvaginal ultrasound and diagnostic hysteroscopy as a predictor of endometrial polyps: risk factors for premalignancy and malignancy

The aim of this study is to assess accuracy of transvaginal ultrasound (TVUS) and diagnostic hysteroscopy in diagnosing endometrial polyps and to determine premalignancy and malignancy rates in asymptomatic women. The study was designed to retrospectively analyze 438 women who underwent operative hysteroscopy in a day-care unit when endometrial polyp was suspected after TVUS and diagnostic hysteroscopy. Multivariate logistic regression modeling showed effects of age, previous breast cancer with tamoxifen treatment, and menopause with or without bleeding on pathologic results. The results indicate that positive predictive value of TVUS with diagnostic hysteroscopy was 79.9%. Premalignancy or malignancy occurred in 3.2% and was significantly related to menopause with abnormal bleeding (P < 0.001), which carried a 20-fold higher risk of pathology than any other group. Age was also a risk factor. It was concluded that TVUS with diagnostic hysteroscopy reliably evaluates endometrial polyps. The low incidence of endometrial tumors in asymptomatic (especially premenopausal) women suggests that their operative evaluation may not be cost effective. Larger studies are needed to support this tentative conclusion.     

Immunohistochemical Study of Colorectal Polyps with Antibodies against CEA,CA19-9, CA125, CA15-3 (DF3), PCNA and p53

Abstract: We analyzed the expression of CEA, CA19-9, CA125, CA15-3 (DF3), PCNA and p53 immunohistochemically in 14 tissue specimens of mucosal cancers in adenoma, seven tubulovillous adenoma specimens, and 16 tubular adenoma specimens. The rates of positive staining for mucosal cancer in adenoma, tubulovillous adenoma and tubular adenoma specimens, respectively, were: for CEA: 100%, 85.7% and 75%; for CA19-9: 71.4%, 71.4% and 56.2%; for CA125:0%, 0% and 0%;for CA15-3 (DF3): 64.3 %, 0% and 0 %; for PCNA: 100%, 88.9% and 56.2%; and for p53: 35.7%, 0% and 0% . The results suggest that the expressions of CEA, CA19-9, CA15-3 (DF3), PCNA and p53 are related to colorectal tumorigenesis. None of the specimens studied showed staining for CA125, suggesting that CA125 is not involved in the early stages of colorectal carcinogenesis. There was no significant difference in the rates of positive staining for CEA and CA19-9 among mucosal cancer in adenoma, tubular adenoma and tubulovillous adenoma specimens. However, the rates of positive staining for PCNA and p53 were significantly higher in mucosal cancer in adenoma specimens than for tubular adenoma specimens (p<0.05), and the rate of CA15-3 (DF3) positive staining was significantly higher for mucosal cancer in adenoma than for tubulovillous adenoma (p<0.01) and tubular adenoma (p< 0.001) specimens. Therefore, the CA15-3 (DF3) antigen is an immunohistochemical marker for colorectal carcinomas. The present results suggest that CA15-3 (DF3), PCNA and p53 play important roles in the genesis of colorectal adenomas.     

子宫内膜息肉中雌、孕激素受体的表达

目的检测子宫内膜息肉雌激素受体(ER)、孕激素受体(PR)的表达,探索子宫内膜息肉形成的原因及机制。方法子宫内膜息肉48例为观察组,正常子宫内膜36例为对照组,采用免疫组化SP法,行半定量分析,检测ER、PR的表达。结果增殖期的息肉组织中PR表达的评分结果为(2.89±2.16),低于增殖内膜的评分(4.04±1.73),差异有统计学意义(P<0.05);分泌期的内膜息肉中ER表达的评分结果为(3.80±1.64),高于分泌期内膜中的评分(2.64±1.45),差异有统计学意义(P<0.05)。结论增殖期的子宫内膜息肉中PR的表达降低及分泌期的息肉中ER表达增高可能参与了子宫内膜息肉的形成及发展。     

输尿管息肉的诊断与治疗(附9例报告)

目的：探讨输尿管息肉的诊断与治疗方法。方法：回顾性分析9例输尿管息肉患者的临床资料，结合文献进行讨论。结果：9例患者中，4例行息肉切除加基底部电灼，2例行息肉切除输尿管肾盂吻合术，2例行病变段输尿管切除再吻合术，1例行肾切除术。全部病例均获治愈并经病理证实。结论：放射学检查是诊断输尿管息肉的主要方法，其特征是边缘光滑锐利的充盈缺损。输尿管息肉的治疗以手术为主，应根据息肉的大小，数量，部位及肾脏受累程度选择局部切除术，输尿部分切除术和肾盂成形术等。     

电子鼻咽喉镜下声带息肉切除术疗效分析(附128例报告)

目的探讨电子鼻咽喉镜下声带息肉切除术的临床疗效。方法应用Dr．Speech4．0嗓音分析软件，对128例在电子鼻咽喉镜下切除声带息肉患者的嗓音声学参数进行分析比较。结果128例声带息肉患者术后7～15天Jitter、Shimmer、NNE、HNR、SNR恢复正常，与术前相比，差异有非常显著性意义(P＜O．01)；而FD与术前相比，差异无显著,Sk(P＞O．05)。结论电子鼻咽喉镜下声带息肉切除术具有操作简单、安全、费用低、疗效好的优点。     

Fibrovascular polyp of the esophagus requiring esophagectomy

Fibrovascular polyps of the esophagus are rare, with only 110 cases reported in the world literature to date. Dysphagia is the most common symptom. The diagnosis is usually made by barium swallow or upper endoscopy, but almost a third of cases can be missed with these studies. Treatment is surgical. Only four cases in the literature underwent esophagectomy for removal. We present a female patient with a fibrovascular polyp of the esophagus who required a transhiatal esophagectomy to safely remove this mass.     

He—Ne激光治疗声带小结的机理研究

我院应用He－Ne激光治疗551例声带小结，取得较好疗效。为研究作用机理，我们进行了免疫功能测定、测温试验、He－Ne激光照射前后的间接喉镜检查、显微结构研究、抑菌试验和过氧化脂质测定。结果提示He－Ne激光照射治疗声带小结的机理为照射后喉部温度升高、血管扩张、血循环加快，从而增强局部营养，促进喉部粘膜生长、消除组织水肿，加速炎性渗出物和毒素的排泄。而He－Ne激光本身没有杀菌和抑菌作用。