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T.F.A. Lees L. Bogdashich D. Godden 《The British journal of oral & maxillofacial surgery》2021,59(1):e9-e12
Fibroepithelial polyps (FEPs) are common, benign intraoral lesions that tend to develop slowly at predictable sites, often in response to local irritation or trauma. Historical precedent often results in referral to oral and maxillofacial surgery (OMFS) departments for biopsy, often irrespective of symptoms, and histological assessment. OMFS and pathology services are struggling to cope with an increasing workload that will potentially lead to widespread delays to diagnosis and treatment. Over the past 20 years, clinical pathways and guidance have been developed to ensure that healthcare interventions, such as the removal of third molars, tonsils, skin tags, and benign moles, are evidence-based, have a net patient benefit, and ensure the best use of finite NHS resources. However, no such guidance exists for intraoral lesions and we regard this as an oversight. We analysed the removal of 682 FEPs over a seven-year period and report sensitivities of 92.4% for a “confirmed clinical suspicion of an FEP” and 99.7% for a “confirmed clinical suspicion of a benign diagnosis”. The incidence of non-benign disease was 0.3%. Primary care dentists should be able to diagnose and monitor FEPs and refer only if symptoms are serious or in high-risk patients or sites. Adopting this practice across the UK could free up to 1825 four-hour OMFS clinics, 405 hours of consultant histopathologists’ time, and recurring savings to the NHS estimated to be in the region of £620 000/annum. We believe that the removal of FEPs should be reclassified as an “intervention not normally funded”, and the time and resources put to better use treating patients with lesions of questionable pathology. 相似文献
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Nirmanmoh Bhatia Buddhadeb Dawn Tariq S. Siddiqui Marcus F. Stoddard 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2015,42(1):16-24
Determining aortic stenosis (AS) severity is clinically important. Calculating aortic valve (AV) area by means of the continuity equation assumes a circular left ventricular outflow tract (LVOT). The full impact of this assumption in calculating AV area is unknown. Predictors of noncircular LVOT shape in patients with AS are undefined.In 109 adult patients with AS who underwent multiplanar transesophageal echocardiography, we calculated AV area by means of the standard continuity method and by a modified method involving planimetric LVOT area.We found 54 circular, 37 horizontal-oval, 8 vertical-oval, and 10 irregular LVOTs. Area derived by direct planimetry correlated better with the modified than the standard continuity method (r=0.89 vs r=0.85; both P=0.0001). Valve areas of patients with mild, moderate, or severe AS by planimetry were more often mischaracterized with use of the standard than modified method (29 vs 18; P <0.0001). Horizontal-oval AV area derived by planimetry (1.28 ± 0.55 cm2) was underestimated by the standard method (1.05 ± 0.47 cm2; P=0.001), but not by the modified method. Congenital AV morphology and low cardiac index were the only multivariate predictors of horizontal-oval shape. Low cardiac index was the only predictor of noncircular shape.More than half our patients with AS had noncircular LVOTs. Using the modified method reduces mischaracterizations of AS severity. Congenital AV morphology and low cardiac index predict horizontal-oval or noncircular shape. These data suggest the value of direct LVOT measurement to calculate AS severity in patients who have congenital AV or a low cardiac index. 相似文献
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背景:组织工程是一个多学科研究的交叉学科,其目标是使人体损伤的组织和器官再生,通过这种假设,几乎所有的动物组织都可以在实验室进行培养。一般的方法是从需要移植的患者身上提取干细胞,在一定的支持条件下允许其生长、增殖、生产为可替换的组织。另一方面,寻找细胞能够互相联结并形成分层结构的合适的支持条件,如基质或支架等非常必要。目前用于烧烫伤治疗的材料有很多种,如胶原,透明质酸、纤维蛋白和聚乳酸及其共聚物。
目的:讨论以新型的生物材料自体血浆为支架对自体成纤维细胞和角质化细胞生长、扩张、增殖的影响。
设计:建立一种真皮再生的方法,将自体成纤维细胞浸于人血浆基质中,排除各种影响样本安全性和排斥反应的问题,应用同样的方法在新的真皮上获取角质化细胞。
时间及地点:实验于2008年在意大利曼多瓦C. Poma医院动物工厂完成。
材料:人角质化细胞和成纤维细胞取自1例58岁乳房切除患者的皮肤碎片。实验得到C. Poma医院独立伦理委员会批准,患者知情同意。
方法:从自体活组织皮肤样本中分离人角质化细胞和成纤维细胞,置于培养瓶中增殖,随后将自体血浆作为皮肤移植形成构造的支架,免疫和免疫组织化学特征显示与正常皮肤相似。
主要观察指标:将血浆样本用甲醛固定,埋入石蜡,苏木精-伊红染色,用显微镜进行细胞计数。所有样本均经免疫组织化学评估。
结果:在血浆基质上获得了多层规则形状的角质化细胞和成纤维细胞,基底膜的形成说明自体血浆是角质化细胞和成纤维细胞的生长、分化、扩展的良好支架,真皮和表皮细胞联结重建皮肤移植与正常皮肤无异。
结论:血浆作为角质化细胞和成纤维细胞分化、扩展的支架表现出良好的性能,同时实验还特别发现成纤维细胞浓缩血浆可以暂时替代皮肤,也是角质化细胞生长的强有力的支架。此外血浆还具有廉价,易于制备等优点。自体角质化细胞和成纤维细胞及自体血浆的应用,可以避免血种类型的免疫排斥反应。这种治疗方法给有慢性缺损并且需要连续移植的患者带来了希望。
doi:10.3969/j.issn.1673-8225.2009.47.001 相似文献
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老年人视网膜中央血管在前部视神经的解剖特征 总被引:1,自引:0,他引:1
目的:观察老年人前部视神经视网膜中央血管的解剖特征。
方法:通过组织连续切片和计算机影像分析,观察60~82岁老年人的18只眼球标本中无解剖变异的视网膜中央动脉(CRA)15条,视网膜中央静脉(CRV)23条在筛板前、筛板区及筛板后的管径变化。
结果:老年人筛板前、筛板区、筛板后CRA平均面积的均值分别为(12.70,17.40,18.00)×10-3mm2;平均周长的均值分别为0.56,0.56,0.57mm,平均周长之间相比无显著差异。CRV平均面积的均值分别为(7.00,5.40,7.90)×10-3mm2;平均周长的均值分别为0.44,0.38,0.41mm;CRV平均周长筛板前与筛板区相比,筛板区与筛板后相比均有显著差异。
结论:老年人CRA眼球内外管径一致;CRV在筛板区管径最小。
(中华眼底病杂志,1997,13:213-214) 相似文献
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研究补肾抗衰口服液对大鼠衰老模型免疫器官胸腺和脾脏的影响.结果显示,模型组大鼠胸腺和脾脏重量减轻,胸腺重/体重比值、脾重/体重比值减小,胸腺组织学观察,显示萎缩改变;药物组大鼠胸腺和脾脏重量、胸腺重/体重、脾重/体重比值接近正常对照组,胸腺组织学观察,未显示萎缩改变.本研究结果表明,补肾抗衰口服液能延缓胸腺和脾脏萎缩,保护机体的正常免疫功能,提示该药有抗衰老的作用. 相似文献
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Endoscopic ultrasound (EUS) is sensitive for staging gastrointestinal malignancies and pancreatic lesions. EUS‐fine‐needle aspiration (EUS‐FNA) offers a diagnostic accuracy of about 60–90% for pancreatic tumors and > 90% for lymph nodes. There are several limitations of EUS‐FNA including the need for on‐site cytopathology review. In addition, accuracy of cytologic review is hampered by the presence of blood, benign epithelial cells, desmoplasia, and well‐differentiated tumors. Furthermore, the small biopsy sample and destruction of tissue architecture limits the diagnostic sensitivity for GISTs and lymphomas. Many of these problems can be overcome with use of EUS trucut biopsy (TCB) needles. These large caliber, cutting needles acquire larger tissue samples allowing preservation of tissue architecture and histologic examination. Our recently described experience with EUS‐TCB initially in swine and later humans demonstrated the safety for acquiring histologic tissue representative of the target organs sampled enabling accurate diagnosis. These studies suggested greater diagnostic accuracy of EUS‐TCB for submucosal mass lesions and lymphoma and potentially the need for fewer needle passes for solid pancreatic neoplasms. In this paper we will review the current TCB literature, device design and technique, help troubleshoot potential problems, and offer opinion as to the utility and role of this new device. 相似文献
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Forty melanocytic lesions were examined in a pilot study, which was followed by a final series of 100 consecutive melanocytic lesions, in order to evaluate the inter-observer reproducibility of the histological criteria proposed for the dysplastic naevus. The specimens were examined in a blind fashion by four observers. Analysis by kappa statistics showed poor reproducibility of nuclear features, while reproducibility of architectural features was acceptable, improving in the final series. Consequently, we cannot apply the combined criteria of cytological and architectural features with any confidence in the diagnosis of dysplastic naevus, and, until further studies have documented that architectural criteria alone will suffice in the diagnosis of dysplastic naevus, we, as pathologists, shall avoid this term. 相似文献