多层螺旋CT增强检查对乳腺病变的诊断价值

目的:探讨多层螺旋CT(MSCT)增强检查对乳腺疾病的鉴别诊断价值。方法:经手术病理证实的84位患者,共检出93例乳腺病变,其中浸润性导管癌57例,粘液癌4例,纤维腺瘤13例,导管内乳头状瘤4例,其他良性病变15例。CT检查先平扫,而后分别于静脉注射对比剂后28s、90s时进行二期增强扫描。对照手术病理结果,分析所有乳腺病变的CT表现。结果:乳腺良、恶性病变的平扫密度之间的差异无统计意义(P>0.05)。乳腺良、恶性病变的形状、边缘及强化形式之间的差异有统计意义(P=1.57×10-4;P=1.75×10-28;P=1.78×10-2)。以25HU为分界点,本组乳腺良、恶性病变动脉期强化程度之间的差别有高度统计意义(P<0.001)。MSCT诊断本组乳腺病变的敏感性为96.7%,特异性为90.6%,阳性预测值为95.2%,阴性预测值为93.5%。MSCT对61例乳腺癌腋窝淋巴结转移的术前检出率为88.8%。结论:多层螺旋CT增强检查在鉴别乳腺良恶性病变方面具有较高的诊断价值。     

Fresh Osteochondral Allograft Resurfacing of the Ankle

Many basic scientific and clinical studies support the utility of small fragment allografting in addressing an extensive spectrum of osteoarticular pathology, with its use in the tibiotalar joint still an evolving application. The operative procedure in the ankle is technically straightforward but demands precision to achieve reproducible results and to minimize early graft failures related to surgical technique. Fresh osteochondral allografting of the tibiotalar joint is best understood as a management strategy in the patient that presents with a symptomatic OLT, or advanced ankle arthropathy at an age or activity level not optimally suited for total joint replacement or arthrodesis. The treatment goal of joint-sparing biologic reconstruction is to relieve pain and maintain function to delay the need for ankle fusion or total replacement indefinitely, while at the same time not restricting future treatment options. The emergence of fresh osteochondral allografting for the ankle has demonstrated encouraging results, but its remaining shortcomings are also testament to the lack of viable treatment options in this challenging patient population.     

夜间发作性心绞痛患者冠状动脉病变分析

目的:探讨夜间发作性心绞痛患者临床表现与冠状动脉造影(CAG)病变形态的关系.方法:选择有心绞痛发作并行冠状动脉造影检查的患者104例,按是否有夜间发作性心绞痛分为两组.A组:51例,患者在行冠状动脉造影检查前至少有一次夜间心绞痛发作;B组:53例,在行冠状动脉造影检查前无夜间心绞痛发作.结果:A组患者冠状动脉的严重狭窄(Ⅲ、Ⅳ级狭窄及完全闭塞),病变发生率明显高于B组,两组间相比,差异具显著性(p＜0.05)结论:夜间发作性心绞痛患者有更为严重的血管病变,宜积极行血运重建术.     

EEG and CT findings in poststroke epilepsy

The present study was undertaken to assess the diagnostic value of CT in patients with poststroke epilepsy, related to EEG in revealing the factors contributing to the development of epileptic fits. The EEG and CT results were evaluated in 50 patients with poststroke epilepsy and compared with those of 50 patients without epilepsy after stroke. Cortical and extensive lesions involving the cortex were more frequent among patients with poststroke epilepsy. Sparing of certain parts of cerebral cortex was observed within vasogenic lesion. This type of change was only found in the poststroke epilepsy group and may be responsible for development of epileptic fits. It seems that CT has a higher diagnostic value than EEG in evaluating the risk of development of poststroke epilepsy.     

Axotomy decreases conduction velocity of unmyelinated sensory fibres

We have examined the effect of axotomy on the conduction velocity of unmyelinated sensory fibres in the vagus nerve of the rabbit. In an in vitro preparation of the nodose ganglion, conduction velocity was calculated for each cell from the latency of the intracellularly recorded action potential evoked by vagus nerve stimulation. The average velocity of sensory fibres conducting at less than 1.1 m/s, was 0.53 m/s in 287 control cells and 0.45 m/s in 269 neurones recorded 10 days after cutting the vagus nerve. Therefore, peripheral axotomy decreases conduction velocity in mammalian unmyelinated sensory axons.     

The effects ofl-DOPA on regional cerebral glucose utilization in rats with unilateral lesions of the substantia nigra

Using [¹⁴C]2-deoxyglucose autoradiography, we have studied the effects of systemically administeredl-DOPA (10, 25 and 50 mg/kg s.c.) on regional cerebral glucose utilization (RCGU) in rats with unilateral substantia nigra lesions. In comparison with lesioned rats treated with saline, the lesioned-DOPA treated rats demonstrated contralateral turning and RCGU changes in both ipsilateral and contralateral brain regions.l-DOPA treatment markedly increased RCGU in the ipsilateral entopeduncular nucleus (EP) and substantia nigra pars reticulata (SNr), cell groups that receive direct striatal input and function as major outflow pathways of corpus striatal activity. In contrast,l-DOPA did not alter RCGU in the globus pallidus (GP), supporting the thesis that dopamine (DA) has different effects on striatal outflow to the GP compared with outflow to both the EP and SNr. Moderate RCGU increases were observed in the ipsilateral subthalamic nucleus (STN), lateral midbrain reticular formation (LMRF), and deep layers of the superior colliculus (DLSC), all regions which receive direct projections from the GP, EP or SNr.l-DOPA decreased RCGU in the ipsilateral lateral habenular nucleus (LHN) and increased RCGU in the contralateral LHN, changes that we suggest are mediated via altered neuronal activity in the striatum and EP. The results suggest that systemically administeredl-DOPA, after conversion to DA in the brain, interacts with supersensitive DA receptors in the DA-depleted striatum to selectively activate efferent pathways. Furthermore, the data suggest that the LMRF and DLSC are functionally activated duringl-DOPA induced turning and support the hypothesis that nigroreticular and nigrocollicular projections are of physiologic significance in the expression of striatal activity.     

Alterations in nociception following lesions of the A5 catecholamine nucleus

Neurons located in the nucleus raphe magnus (NRM), a region important in the control of nociception, appear to be tonically inhibited by noradrenergic (NA) neurons. Anatomical studies have suggested that the A5 catecholamine nucleus may be the primary source of noradrenergic neurons whose terminals are located in the NRM. The purpose of the present study was to examine the role of A5 neurons in the modulation of nociception. Bilateral electrolytic lesions of the A5 nuclei produced a marked and long lasting antinociception as assessed by both the tail-flick and hot-plate tests. Unilateral A5 lesions also produced a long-lasting elevation in hot-plate latency, but the elevation of tail-flick latency was smaller in magnitude and was only observed one day following the lesion. This finding is consistent with previous studies which have shown that blockade of the NA input to the NRM by the microinjection of NA antagonists also produces antinociception. These data indicate that neurons located in the A5 nucleus may be the origin of this NA projection to the NRM. The elevation in tail-flick latency observed following A5 lesions was significantly attenuated by the intrathecal injection of either the NA antagonist phentolamine or the serotonergic antagonist methysergide. However, the elevation in hot-plate latency was not significantly altered by these monoaminergic antagonists. Similarly, previous studies have shown that the elevation in tail-flick, but not hot-plate latency, produced by the microinjection of NA antagonists in the NRM is attenuated by the intrathecal injection of either phentolamine or methysergide.(ABSTRACT TRUNCATED AT 250 WORDS)     

S100 PROTEIN-POSITIVE DENDRITIC CELLS AND THE SIGNIFICANCE OF THEIR DENSITY IN GASTRIC PRECANCEROUS LESIONS

Quantitative analysis of dendritic cells (DC's) was carried out in tissue specimens of normalgastric mucosa (n=15),gastric ulcer (n=19),chronic atrophic gastritis (n=28),and gastriccarcinoma (n=65) by ABC immunostaining with S100 protein antibody.Significant increasein DC number were observed in chronic atrophic gastritis with type Ⅲ intestinal metaplasiaand/or grade Ⅱ,Ⅲ dysplasia.The result suggests that DC's are potentially capable opresenting neoantigens associated with malignant transformation at the precancerous stagewhen malignant morphological changes have not yet taken place.Combined with routinediagnostic methods,the serial monitoring of DC density in gastric mucosa may be usefulin the follow-up of premalignant lesions in the stomach and the diagnosis of early gastriccarcinoma.     

肾上腺囊性占位性病变的诊治分析

目的:提高肾上腺囊性病变的诊治水平。方法:回顾性分析38例肾上腺囊性病变患者的临床资料,经影像学、手术及病理检查证实,其中非肿瘤源性囊性病变30例,肿瘤源性囊性病变8例。结果:囊肿内出血、感染或自发性出血所致高密度囊肿24例,单纯性囊肿6例。前者均有不同程度的腰、背、腹部胀痛,其中3例伴有贫血,2例伴有肝功能异常;后者均无临床症状。B超检查肿物内无血管,CT、MRI增强扫描肿物无强化,内分泌检查正常。肿瘤源性囊性病变患者中,嗜铬细胞瘤5例,皮质腺瘤2例,节细胞神经瘤1例。5例有激素活性症状,内分泌检查部分有相应激素水平升高。B超、CT、MRI显示囊壁>0.3 cm,且厚薄不均,CT、MRI增强扫描后,囊壁可有强化,以嗜铬细胞瘤囊壁强化最为显著。手术治疗36例,除1例因车祸、1例因脑血管意外死亡外,34例效果满意。结论:B超、CT、MRI可帮助诊断肾上腺囊性病变。无论是非肿瘤源性肾上腺囊性病变,还是肿瘤源性肾上腺囊性病变,只要条件允许,均应手术治疗。     

Intraosseous calvarial meningioma of the skull presenting as a solitary osteolytic skull lesion: Case report and review of the literature

Summary Intraosseous calvarial meningiomas, defined as meningiomas confined to the skull with no epidural or subcutaneous component, are rare and usually exhibit osteoblastic activity. We present a case of a primary intraosseous meningioma in the right frontal bone that presented radiologically as a solitary lytic skull lesion and was completely excised. The lesion was benign without recurrence for 11/2 years. According to our review of the literature, our case is the first with documentation on computed tomography. In cases of solitary osteolytic skull lesions, meningioma should be considered even though it may not seem likely, because management will be directed to radical excision with good prognosis rather than biopsy.