Eliminating the Need for Dietary Restrictions When Using a Sensitive Guaiac Fecal Occult Blood Test

When using the peroxidase-sensitive guaiac fecaloccult blood test, Hemoccult Sensa (HOS), dietaryrestrictions are recommended so as to reduce its falsepositivity from ingested peroxidases. As dietary restrictions could reduce compliance for annualretesting, we reexamined their need. HOS was given to944 persons in an endoscopic screening/follow-upprogram. Only the first 403 received instructionsregarding a low peroxidase-containing diet for three daysbefore and during HOS collection. Development wasdelayed 3-14 days after HOS preparation, and there wereno significant differences in duration before HOS development in examinees with or withoutcolorectal neoplasia and having or not having a positivetest. Of the 901 persons without endoscopic evidence ofneoplasia, 377 had received and 524 had not received instructions on dietary restrictions. Their HOSpositivity was 7.2% and 5.5%, respectively (P = 0.26).When using HOS, delaying development by 3-14 days allowsbreakdown of ingested peroxidases, so dietary restrictions are not needed in our population,which has a low red meat intake.     

72例原发性小肠肿瘤的临床分析

目的 探讨小肠原发性肿瘤的外科诊治经验，以提高对原发性小肠肿瘤的诊治水平。方法 回顾性分析1988—2002年收治的72例原发性小肠肿瘤的临床资料。结果 72例中，良性肿瘤占20．8％(15／72)，恶性肿瘤占79．2％(57／72)。良性肿瘤以腺瘤及平滑肌瘤多见，各占40．0％(6／15)。恶性肿瘤以腺癌多见，占36.8％(21／57)，其次为恶性淋巴瘤，占30．0％(17／57)。X线检查是主要诊断手段，B超、CT、内镜、肠系膜血管造影也有助于诊断。本组术前误诊率为62．5％。全组均行手术治疗，其中急诊手术率为33．3％(25／72)，术前主要以急性肠梗阻、消化道出血、穿孔、急性阑尾炎等为主要诊断。本组无手术死亡。恶性肿瘤1，3，5年生存率分别为72．5％，47．5％，25．0％。结论 小肠肿瘤术前诊断困难，误诊率与急诊手术率高。选择性动脉造影和小肠分段造影是空回肠肿瘤的重要诊断手段；低张造影和纤维内镜检查是诊断十二指肠肿瘤的最佳选择。一经诊断，手术治疗是最佳选择。     

Performance Characteristics and Comparison of Two Immunochemical and Two Guaiac Fecal Occult Blood Screening Tests for Colorectal Neoplasia

A new immunochemical test for stool Hb, FlexSureOBT, was compared with the immunochemical HemeSelect andguaiac Hemoccult II and Hemoccult SENSA tests. Blindeddevelopment of test cards smeared with stools having added human blood showed betteranalytical sensitivity of FlexSure OBT (0.2 ml blood/100g feces), than Hemoccult SENSA (0.5 ml) or HemoccultII (1.0 ml). All four stool tests were prepared by 403 subjects having endoscopic examinations.The guaiac tests and FlexSure OBT were easy to prepareand develop. The positivity rate of Hemoccult SENSA was8.7%, Hemoccult II 6%, FlexSure OBT 4.2%, and HemeSelect 3.4%. In this mainly asymptomatic(97%) population, 98% were free of clinicallysignificant neoplasia (five had cancers, three hadadenomas 1.0 cm). Sensitivity for cancers oradenomas 1.0 cm was similar for all tests (62.5-86%, NS) andHemoccult SENSA had the lowest specificity (92% vs95-98%, P < 0.05); but both Hemoccult II andHemoccult SENSA had significantly lower predictivepositive values (21% and 14%) than either FlexSure OBT(29%) or HemeSelect (50%) (P < 0.05). If bothHemoccult SENSA and FlexSURE OBT were positive in thesame subjects (1.7%), sensitivity for cancer or adenomas 1.0 cm (50%) was not significantly betterthan guaiac tests, but specificity (99.2%) andpredictive positive (57%) values were improved (P <0.05). In this population, guaiac tests were assensitive as immunochemical tests for clinically significantcolorectal neoplasia, but with significantly lowerpredictive positive values. A combination of a sensitiveguaiac test (Hemoccult SENSA) and a specificconfirmatory test for human Hb (FlexSure OBT) provided highspecificity, comparable to HemeSelect.     

经额外侧入路切除鞍区占位病变技术探讨

目的 介绍经额外侧入路及显微手术技术切除１例颅咽管瘤,２０例大型、巨大型垂体腺瘤的经验。方法 所有病人均采用经额外侧入路。垂体腺瘤切除的要点：（１）先切除鞍内鞍上的大部分肿瘤;（２）电灼并切断来视神经、视交叉、颈内动脉及硬脑膜等处的肿瘤新生血管,切断一切供瘤及引流血管;（３）分片切除鞍上的瘤壁,电灼鞍内的瘤壁,同时全切残作的肿瘤;（４）保护好垂体柄。结果 １例颅咽瘤壁,予以全切;２例大型、巨大型垂     

桥本病并甲状腺腺瘤的诊断与治疗

目的 探讨桥本病(HD)并甲状腺腺瘤(TA)的诊断与治疗。方法 对50例HD并TA的临床资料进行回顾性分析。结果 50例中，术前诊断为HD并TA者仅8例，误诊、漏诊达84．0％。术中快速切片确诊率为81．4％(35／43)。术后病理切片确诊50例。根据患者具体情况采取不同范围的甲状腺切除术。术后27例口服小剂量甲状腺素，2例口服小剂量强的松。所有患者均获随防，随访时间为3个月～1年，未发生甲状腺机能减退者。结论 全面的血清免疫学检查、B超、细针抽吸细胞学检查有助于诊断。HD并TA应予以手术治疗。术中快速切片对确诊有重要价值。其手术方式、切除范围及术后药物治疗应个体化，尽可能避免术后甲状腺机能减退的发生。     

单侧探查治疗甲状旁腺腺瘤的可行性探讨

目的 探讨术中单侧探查治疗甲状旁腺腺瘤的可行性。方法 回顾性分析我院7年间收治的l5例甲状旁腺腺瘤的临床资料，及采用术前影像学定位和术中单侧探查的经验。结果 在术前超声，CT，MRI及99mTc-MIBI核素扫描检查指导下，l5例甲状旁腺腺瘤的单侧探查均获得成功，临床治疗效果满意。结论 若有良好的术前影像学定位，甲状旁腺腺瘤的单侧探查是可行的。     

Application of phase sensitive imaging (PSI) for hemorrhage diagnosis in pituitary adenomas

Abstract

Objective: Intratumoral hemorrhaging is a common occurrence in pituitary adenomas. Asymptomatic pituitary apoplexies have become more frequently diagnosed due to recent advances in magnetic resonance (MR) imaging. The purpose of this study was to investigate the usefulness of phase sensitive imaging (PSI) in the diagnosis of hemorrhages within pituitary adenomas.

Patients and methods: PSI methodology was applied to 28 patients with surgically diagnosed pituitary macroadenomas, and compared with conventional methods. No patients presented with sudden onset of apoplectic symptoms. A 3·0 T MR unit was used to examine all patients before surgery.

Results: Seventeen of 28 cases exhibited a hemorrhage component on PSI. However, hemorrhaging was demonstrated in 13 of 28 cases by T2-weighted imaging (T2WI). Hemorrhaging was detected in pituitary adenomas by PSI, but not by T2WI, in four of 17 cases. Poor visualization of the hemorrhage in the sellar turcica was a drawback, which was due to PSI artifacts.

Conclusion: We suggest that PSI be used to provide diagnostic assistance for pituitary apoplexies.     

甲状腺腺瘤术后内分泌治疗的研究

目的 探讨甲状腺腺瘤术后内分泌治疗的必要性。方法 对１００例次手术后甲状腺腺瘤标本用ＳＰ法测定ＴＳＨ受体,瘤体周围的甲状腺组织连续病理切片检查有无存在微小瘤灶,并按随机抽签法将病人分成Ａ、Ｂ两组,Ａ组口服甲状腺片治疗,Ｂ组不用任何治疗。术后定期测定血Ｔ３,Ｔ４,ＴＳＨ浓度,＾１３１Ｉ扫描及Ｂ超检查残存甲状腺。结果 甲状腺瘤１００％存在ＴＳＨ受体,８％有微小瘤灶。Ａ组病人血Ｔ３,Ｔ４,ＴＳＨ及残存甲     

十二指肠良性肿瘤的诊断和治疗

目的 探讨十二指肠良性肿瘤(BTD)的诊断和治疗方法。方法 回顾性分析21年间经手术和病理证实的24例BTD患者的临床资料。行肿瘤局部切除术l8例，十二指肠节段切除术4例，毕I式胃大部切除术l例，保留幽门的胰十二指肠切除术l例。结果 BTD临床上多表现为腹痛、上消化道出血和高位肠梗阻。气钡双重造影和十二指肠镜检查对十二指肠良性肿瘤的确诊率分别为82．4％和93．3％。手术后疗效满意，l例于术后6d死于心肌梗塞。病理检查结果为绒毛状腺瘤8例，间质瘤6例，Brunner腺瘤5例，平滑肌瘤和家族性腺瘤性息肉病十二指肠腺瘤各2例，血管瘤l例。结论 十二指肠气钡双重造影及十二指肠镜检查是诊断本病的主要方法；治疗首选手术切除。