产后出血63例临床分析

产后出血指胎儿娩出后24小时内阴道出血量≥500ml,是分娩期严重并发症,其发生率占分娩总数2%～3%〔1〕,目前仍是我国产妇死亡的首要原因。因此,积极寻找产后出血     

跪卧式排尿用于胎膜早破孕妇的临床观察

目的探讨胎膜早破孕妇待产期间有效的排尿体位,既能最大限度预防脐带脱垂又能有效地排尿,防止尿储留的发生。方法将观察对象随机分为观察组、对照组,分别采取仰卧位排尿和跪卧式排尿,比较两组产妇尿储留发生率、脐带脱垂率、新生儿窒息率、剖宫产率,并进行统计学处理。结果两组产妇尿储留发生率、剖宫产率差异有统计学意义,对照组明显低于观察组。脐带脱垂率与新生儿窒息率差异不明显无统计学意义。结论跪卧式是胎膜早破产妇待产期间安全有效的排尿姿势。     

结缔组织病的危险因素研究

结缔组织病的危险因素研究叶冬青，张丽华，朱雪梅，马俊勤，戴苡，路红，郑惠玲，王玉琴本次研究目的是对结缔组织病（ＣＴＤ）的危险因素进行探讨，提供病因线索。１材料与方法对安徽医科大学第一附院和省立医院两所省级医院近５年来诊断为ＣＴＤ的５５例现存病人，采用...     

静脉留置针在分娩室的应用与护理

静脉留置针技术以其众多的优点广泛应用于临床，产妇临产后由于受宫缩的刺激导致烦躁不安、躁动，运用腹压等原因，使用一般输液针头输液易出现渗漏、堵塞、脱出等情况。2003年6月起，我科将静脉留置针应用于分娩时输液，避免了上述缺陷，保证了药物的顺利应用，效果满意，现报道如下。     

肠道菌群在IBD肠外表现发生中作用的研究进展

炎症性肠病（IBD）是一种病因不明的慢性非特异性炎症性疾病,有相当一部分IBD患者会出现肠外表现（EIMs）。目前,EIMs发生的具体机制尚不完全清楚。普遍认为,EIMs发生相关的因素与IBD相同或相似,是遗传、免疫、环境、感染等因素共同作用的结果。近年来,肠道菌群在EIMs发生机制中的潜在作用备受关注。目前认为,分子拟态、肠黏膜屏障损伤导致肠道微生物移位、肠道微生物代谢产物及衍生因子改变等,均参与EIMs的发生、发展。因此,深入探索肠道菌群在EIMs发生中的具体机制及作用靶点,将为EIMs预防和治疗提供新的思路。     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.

Abstract：

Objective To evaluate the role of breast MRI in detecting the primary malignancy in patients presenting solely with axillary lymph node metastases. Methods Thirty-three patients with axillary lynph node metastases but negative findings on either physical examination or mammography underwent breast MRI to identify occult breast carcinoma. MRI of the breast was assessed according to BI-RADS criteria. The pathologic diagnosis was made according to the standard criteria by the WHO Classification of Tumor. Results Among 33 patients presenting solely with axillary metastases, 30 patients underwent modified radical mastectomy. Primary breast carcinoma was proven in 17 patients. MRI detected lesions in 16 patients, including 10 masses and 6 non-mass lesions. Size of the masses ranged from 0. 5 to 2. 6 cm (mean 1.5 cm). Six lesions were smaller than 1.5 cm in size. Non-mass lesions showed ductal enhancement in 4 cases and segmental enhancement in 2 cases. One patient with tumor detected by histopathology showed no abnormal enhancement on MRI. No tumor was found at mastectomy in the other 13 womeu, and negative MR findings were revealed in 9. Four cases with suspicious enhancement on MRI had no corresponding primary foci on pathology. Three patients didn't undergo surgical procedure. The sensitivity, specificity, and accuracy of MRI in the diagnosis of the primary malignancy were 94. 1%,69. 2%, and 83.3%, respectively. Conclusions Small size of mass and ductal or segmental enhancement of non-mass lesion were common MR features of occult malignancy. MRI showed high sensitivity and accuracy in diagnosing occult breast carcinoma. Breast MRI should be taken in search of occult malignancy in patients with axillary metastases.     

Breast MRI in patients with occult breast carcinoma: evaluation on feasibility and correlation with histopathologic findings

Background As an uncommon presentation, occult primary breast cancer remains a diagnostic and therapeutic challenge in clinical practice. Our study was to retrospectively assess the feasibility of breast MRI in patients with malignant axillary lymphadenopathy and unknown primary malignancy, and correlated with histopathologic charateristics. Methods A total of 35 women with occult breast carcinoma were evaluated with dynamic contrast-enhanced breast MRI. Whole seriate section was used in all cases. MRI performance was assessed and correlated with histopathologic findings. Results Twenty-one of 35 patients were found to have primary breast carcinoma histologically. 20 of the 21 patients had abnormal MR findings and 1 patient had a normal MRI study. Of the remaining 14 patients, 10 were both negative on MRI and surgery. 4 had suspicious enhancement on MRI and no corresponding tumor was found. Lesions with mass enhancement were found in 55% (11/ 20) and ductual and segmental enhancement in 45%. The average diameter of the primary tumors was 15mm. Invasive ductal carcinomas were found in 81% (17/21). One of 17 invasive ductual carcinomas was too small to be graded. 14 of the remaining 16 were classified as grade II and 2 as grade I. 32 of the 35 patients had received ER、PR and Her 2 examinations and the 12 of 32 were triple-negative breast carcinoma. Conclusions Mass lesions with small size and lesions with ductal or segment enhancement are common MR features in patients with occult breast cancer. The dominant types of primary tumors are invasive ductal carcinoma with moderate histopathological grade. The rate of triple-negative breast carcinoma may be higher in occult breast cancer.     

乳腺血氧功能成像技术与超声及X线检查联合应用诊断乳腺癌的价值

目的探讨血氧功能成像技术在乳腺癌诊断中的应用价值。方法回顾性分析201例乳腺病变患者临床资料,其中手术病理证实良性病灶140例、恶性病灶61例。分别行乳腺血氧功能成像、超声、X线单项检查及联合检查,分析其诊断乳腺癌的敏感性、特异性和准确性。结果血氧功能成像系统、超声、X线检查诊断乳腺癌的敏感性分别为77.14%、94.29%和90.71%,特异性分别为54.10%、86.89%和83.61%,准确性分别为70.15%、92.04%和88.56%,差异具有统计学意义(P<0.05)。超声、X线分别联合血氧功能成像检查诊断的敏感性提高。结论血氧功能学成像技术与超声及X线检查联合应用可提高乳腺癌诊断的敏感性,可作为乳腺影像学检查的有益补充。     

不同乳腺影像学检查及其新技术对乳腺癌新辅助治疗评估的价值与比较

<正>乳腺癌已成为全球第一大癌[1],新辅助治疗(NAT)作为乳腺癌综合治疗的一种重要手段,主要包括新辅助化疗、新辅助靶向治疗及新辅助内分泌治疗[2]。《中国乳腺癌新辅助治疗专家共识》(2022版)更新推荐采用超声(US)、乳腺X线、乳腺MRI、胸部CT等影像学检测手段对原发灶、 区域淋巴结、常见转移部位(肝、肺)等进行基线和NAT后的疗效评估[3]。本文着重介绍乳腺癌NAT中评估原发灶及区域淋巴结常用的检查方法：乳腺X线摄影、US及MRI。