性腺外恶性生殖细胞肿瘤37例临床病理分析

目的 探讨性腺外恶性生殖细胞肿瘤的病理类型和临床特点。方法 根据WHO肿瘤国际组织学分类(第2版)对37例性腺外恶性生殖细胞肿瘤重新评价，部分病例做相应免疫组化染色，并将肿瘤的组织类型和临床特点与性腺恶性生殖细胞肿瘤进行比较分析。结果 患者年龄1．5～58岁，中位年龄24岁。男性28人，女性9人，男女之比为3．1：1。发生于纵隔28例，腹膜后5例，前列腺、骶尾部、鞍区、阴道各1例。列前三位的肿瘤分别是卵黄囊瘤、畸胎瘤(未成熟畸胎瘤、PNET和畸胎瘤恶变)和精原细胞瘤，另有5例为混合型生殖细胞瘤。结论 性腺外恶性生殖细胞肿瘤相对少见，预后差，发病率与年龄、性别关系密切，好发部位为纵隔和腹膜后，卵黄囊瘤最为多见。     

肺内畸胎瘤的诊断特点分析(附1例报道)

正畸胎瘤是来源于生殖细胞的肿瘤,具有向体细胞分化的潜能,大多数畸胎瘤至少含有两个或两个以上胚层组织成分。临床上主要好发于性腺,性腺外畸胎瘤好发于胚胎发育异常而残留的生殖细胞,好发部位依次为前纵隔、骶尾部、腹膜后、脑等中线部位[1]。肺内畸胎瘤是指纵隔内无畸胎瘤而原发于肺内,并且被肺实质所包围或位于支气管腔内的畸     

婴幼儿咽部畸胎瘤1例报告

畸胎瘤是小儿常见的肿瘤之一,是三种原始胚层组织演变而来的先天性肿瘤,好发部位是身体的中线及两旁,如骶尾部、腹部、腹膜后和性腺,咽部畸胎瘤较少见.我科收治婴幼儿咽部畸胎瘤1例,现报道如下.     

胎盘畸胎瘤1例报道

正畸胎瘤来源于胚胎生殖细胞,多见于性腺,如卵巢、睾丸,也可发生于身体其他部位,如前纵隔、腹膜后、骶尾椎区等部位,少见于四肢、大脑等部位。发生于胎盘的畸胎瘤极为罕见~([1])。检索现有常用中、英文数据库发现,截止目前,中文文献报道20余例,英文文献报道30余例,大多为成熟性畸胎瘤,偶有未成熟性畸胎瘤报道~([2])。胎盘畸胎瘤的最终确诊依赖病理诊断。本文报道1例胎盘畸胎瘤,并回顾相关文献,论述胎盘畸胎瘤的病理诊断及鉴别,以提高对胎盘畸胎瘤的认识。     

肾脏畸胎瘤：一例报告及文献复习

先前对畸胎瘤较大量的报道,多集中于骶尾部、性腺、纵隔、头颈部等位置。即使腹膜后畸胎瘤的报报道也未涉及到肾脏,笔者发现一例肾脏畸胎瘤。病例报告患者,女,6岁。发现右中上腹部包块4年。无疼痛、发热及其它不适。门诊以“右肾     

原发性椎管内畸胎瘤6例临床病理分析

目的探讨原发性椎管内畸胎瘤的临床病理特点。方法收集手术切除的原发性椎管内畸胎瘤6例,复习其临床资料,光下观察组织形态,并结合文献讨论。结果 6例患者男女各3例,年龄24～47岁,平均年龄31岁;肿瘤部位腰段4例,颈段1例,骶尾部1例,均位于髓外硬脊膜下。5例囊性成熟性畸胎瘤,镜下可见成熟的鳞状上皮、消化道及呼吸道柱状上皮、纤维平滑肌组织、脂肪组织等;1例囊性畸胎瘤,局部癌变为腺癌,镜下除可见成熟囊性畸胎瘤成分外,局灶柱状上皮细胞有癌变,癌细胞明显异型性,呈腺样或实性条索状排列,侵犯囊壁。结论原发性椎管内畸胎瘤少见,主要发生于中青年,多位于胸、腰段椎管髓外硬膜下;病理类型多为囊性成熟性畸胎瘤,极少数可以癌变。     

产前超声对胎儿骶尾部畸胎瘤的诊断价值

目的探讨胎儿骶尾部畸胎瘤产前超声表现及超声诊断价值。 方法对2000年2月至2015年11月在解放军总医院产前超声检查及剖宫产娩出后手术病理检查证实骶尾部畸胎瘤的15例胎儿的超声病理资料进行回顾性分析。 结果15例胎儿产前超声表现：（1）8例胎儿骶尾部肿瘤大小（4.3±2.7）cm,其内以囊性为主回声5例、囊实混合性回声2例、实性为主回声1例,其内见钙化样强回声7例,未见钙化样强回声1例;肿瘤内均未见明显血流信号;超声诊断畸胎瘤Ⅰ型1例、Ⅱ型1例、Ⅲ型3例、Ⅳ型3例;手术病理均诊断为成熟性畸胎瘤。（2）7例胎儿骶尾部肿瘤大小（11.6±5.1）cm,其内均以实性回声为主;多血供5例,少血供2例;7例均可见钙化样强回声分散于低回声内;合并羊水过多5例;超声诊断畸胎瘤Ⅰ型2例、Ⅱ型3例、Ⅲ型1例、Ⅳ型1例;手术病理均诊断为未成熟性畸胎瘤。 结论产前超声可显示胎儿骶尾部畸胎瘤的部位、大小、内部回声、血流信号及其与周围脏器的关系,产前超声正确诊断对胎儿预后判断及分娩方式的选择有重要参考价值。     

胎儿骶尾部先天性未成熟畸胎瘤尸检1例报道并文献复习

目的探讨胎儿骶尾部先天性未成熟畸胎瘤的临床病理特征、诊断及鉴别诊断。方法分析1例胎儿骶尾部先天性未成熟畸胎瘤的临床资料、尸检病理结果,并结合文献复习。结果 B超示胎儿脊柱骶尾部囊、实性混合回声。尸检发现胎儿骶尾部可见5.5 cm×5 cm×4 cm大小肿物,切面呈囊实性,囊内含淡黄色液体。光镜下肿瘤由多个胚层组成,可见角化的鳞状上皮、纤毛上皮、软骨、平滑肌、肠管、内胚窦样结构、神经胶质细胞和原始神经管。免疫组化:小管样结构细胞nestin、vimentin和CD99(+),GFAP、NF和Neu N(-);周围神经胶质细胞GFAP和NF(+),Neu N(-);上皮细胞CK(+),内胚窦样结构S-100(+);Ki-67阳性率为20%,p53(-)。结论胎儿骶尾部先天性未成熟畸胎瘤罕见,确诊依赖于B超、组织学形态和免疫组化结果,需要与成熟性畸胎瘤和原始神经外胚层肿瘤鉴别。     

肿瘤标志物CA199测定在卵巢成熟性畸胎瘤诊断中的临床价值

卵巢畸胎瘤的种类有好几种．包括成熟畸胎瘤和未成熟畸胎瘤等。其中97％是卵巢成熟性畸胎瘤（mature cystic ter-atoma,MCT）．属良性肿瘤,又称皮样囊肿．占卵巢肿瘤的10％-20％．占卵巢生殖细胞肿瘤的85％-97％。因它与妊娠无关．所以卵巢成熟性畸胎瘤可发生在任何年龄,但80％-90％为20—40岁的生育期女性,由于其有恶变的可能,其恶变率为1％-2％,多见于绝经后妇女．因此术前的正确诊断以及早期诊断对于患者的处理及预后具有十分重要的意义。而未成熟畸胎瘤属恶性肿瘤,肿瘤由分化程度不同的未成熟组织组成．发病率很低,有转移、侵蚀、种植的特性,好发于青少年及儿童。本研究通过对初治的125例卵巢畸胎瘤患者进行肿瘤标志物CAl99、CA125、CA153、CEA、AFP的测定．旨在探讨各种肿瘤标志物尤其是CA199对于监测MCTs的临床价值。     

77例小儿骶尾部畸胎瘤治疗体会

畸胎瘤是小儿常见肿瘤之一,以骶尾部发生率最高,其次为卵巢、腹膜后,也可发生于纵膈、睾丸、肺等部位。我院从1968～1980年共收治骶尾部畸胎瘤77例,现分析如下。临床资料年龄、性别: 本组77例中,男26例、女51例。男女之比约为1:2。就诊年龄最小的10天,最大15岁。其中2个月～3岁60例,占85.7％。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.