目的 探討不典型胎盤早剝的臨床特點。 方法 對2008年5月－2009年5月收治的55例胎盤早剝患者的臨床資料進行回顧性分析。其中產前漏診30例，疑診15例，確診10例。胎盤早剝的產前確診率為18.2%，漏診率為54.5%。所有患者均經產后證實。 結果 重度子癇前期（25.5%）、胎膜早破（12.7%）是胎盤早剝的主要發病誘因；陰道流血（52.7%）、腰腹痛（47.3%）及胎心異常（36.4%）是其常見的臨床表現。胎盤早剝者，剖宮產率、胎兒窘迫及早產率均增加。 結論 不典型胎盤早剝病情隱匿。后壁胎盤、早剝面積小及B型超聲檢查陰性是漏診的主要原因。對此患者應提高認識，動態監測，及時處理，以改善母嬰結局。
To investigate the changes of tenascin (TN) expression during the course of canceration through atypical hyperplasia of breast epithelia. The SP immunohistochemical method was used to study TN expresson in 50 different breast tissues. Results: There was no TN expression in normal breast and grade Ⅰ hyperplasia; immunostaining of TN was detected in 2 cases with grade Ⅱ atypical hyperplasia; the expression of TN in grade Ⅲ atypical hyperplasia (80%) and infiltrating ductal breast cancer (90%) was significantly higher than that in grade Ⅱ atypical hyperplasia (20%); and immunostaining of TN was detected in part of the cancer cells. Conclusion: These results suggest that TN expression in the stroma of serious atypical hyperplasia may play a role in limiting the outgrowth of hyperplastic epithelia.
Barrett’s esophagus is considered an important risk factor for the pathogenesis of esophageal adenocarcinoma. Treatment strategies for diseases from high-grade dysplasia （HGD） to adenocarcinoma are different. The recurrence rates of endoscopic treatment and anti-reflux surgery are comparatively higher. Abnormal lesions of the esophagus can be completely resected by esophagectomy for the treatment of HGD to adenocarcinoma, and treatment outcomes are confirmed.But appropriate surgical strategies and lymph node dissection scopes should be chosen according to different cancer staging.Lymph node metastasis is a major factor in determining prognosis.
Thymic epithelial tumors represent the most common neoplasms of the anterior mediastinum, while atypical type A thymoma is a rare subtype of thymoma. On the morphological basis of type A thymoma, this tumor exhibits some atypical histological features, such as abundant cells, increased mitotic counts, tumor necrosis, and increased Ki67 index. At present, the clinical and pathological data of this tumor is still available. Since it was formally named, 16 cases have been reported around the world. In order to improve the understanding of the disease, this article reviews the related literature and tries to elaborate the atypical type A thymoma from the aspects of pathological features, clinical manifestations, epidemiology and differential diagnosis.
ObjectiveTo systematically review the overall diagnostic efficacy of Gd-EOB-DTPA-enhanced MRI in differentiating dysplastic nodules (DNs) and hepatocellular carcinoma (HCC), exploring whether the hepatobiliary phase can effectively improve diagnostic accuracy. MethodsThe PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang Data, and CBM databases were searched from January 1998 to March 2023 to identify original studies on Gd-EOB-DTPA-enhanced MRI for the differential diagnosis of DNs and HCC. Two investigators independently performed literature screening, extraction of data features and quality assessment. Meta-analysis was performed using Stata 17.0 and Meta-disc1.4 software. ResultsA total of 14 papers were included in this meta-analysis, including 375 DNs and 653 HCC. The results of meta-analysis showed that, in the multiparametric diagnostic sequence, the pooled Sen, Spe, PLR, NLR and AUC were 0.95 (95%CI 0.87 to 0.98), 0.95 (95%CI 0.91 to 0.97), 18.57 (95%CI 9.64 to 35.78), 0.06 (95%CI 0.02 to 0.14) and 0.98 (95%CI 0.97 to 0.99), respectively. ConclusionGd-EOB-DTPA-enhanced MRI has a good differential diagnostic value for DNs and HCC. Hepatobiliary phase imaging also greatly compensates for the diagnostic deficiency of dynamic enhancement with low sensitivity for early HCC.
Objective To investigate the clinical and EEG characteristics, therapeutic response and prognosis in children with atypical absence seizures. Methods The clinical and EEG data of 43 children with atypical absence seizures in Qilu Hospital, Shandong University during January 2011 to December 2016 were analyzed, and therapeutic response and prognosis were followed up. Results Childre were 24 male and 19 female with the mean age of 5.43 y. The onset ages were from 1 years and 8 months to 10 years and 3 months. All of the 43 patients had MRI examines, and 18 children were normol. MRI abnormalities appeared in 25 children, including cerebral cortical dysplasia and cerebral atrophy (13 cases), congenital corpus callosum hypoplasia (2 cases), and abnormal signal in bilateral posterior putamen (2 cases), encephalomalacia focus(4 cases), ventricle expention (2 cases), hydrocephalus(2 cases). All the children underwent EEG more than once. All children had atypical absence seizures during daytime. Children had slowly backgrounds in retesting EEG, and spine and slow waves of 1.5 Hz to 2.8 Hz could be seen in all the atypical absence seizures. All children were followed up, and except 6 children with complete control, 19 children’ parents reported seizure- free, 18 children have poor effect. Forty Children had various degrees of psychological abnormalities and motor regression. Among them 13 cases had psychological abnormalities and motor regression before disease; cognitive ability of 27 cases were normal before onset age, however, about 75% to 95% of the children became abnormal 2 years after atypical absence seizures. The rest 3 cases had no obviously impairment. Conclusions Most of the atypical absence seizures children had small onset age and high incidence in mental damage and cognitive impairment. The course of typical absence seizures aggravate gradually, and often develops to nonspecific brain damage in this process. Antiepileptic drugs can reduce the frequency of the seizure in part of the patients, but had no effect on psychological and motor regression.
Objective To discuss the surgical indication of mammotome （MMT） operation and its auxiliary diagnosis value on breast cysts. Methods Seventy-eight patients with breast cysts from May 2010 to November 2011 in this hospital were enrolled. Excision and biopsy were performed according to the following guidelines：Single cyst with inhomogeneous interna echoes and diameter at least 1 cm；Multiple cysts associated with irregular megalgia， localized thickening of breast or ineffective drug treatment after three months；High risk of breast cancer；Hypoechoic nodules and laticifers exaggerated cysts；Ultrasonography showed disorderly echo and abundant blood supply in glandular tissues around the lesions. The result of preoperative ultrasound was compared with that of postoperative pathology diagnosis. Results In these 78 breast cysts patients with preoperative ultrasound diagnosis， 40 cases were breast multiple cysts， 38 cases were multiple cysts plus untouchable hypoecho nodules；42 cases were high risk lesions， and the other 36 cases were low risk lesions. Postoperative pathology diagnosis revealed 27 cases of cystic hyperplasia， 2 cases of atypical hyperplasia， and 1 case of breast cancer in the ultrasonic high risk lesions， and 19 cases of cystic hyperplasia in the ultrasonic low risk lesions. Ultrasound diagnostic accuracy rate was 60.26%（47/78）， sensitivity was 61.22%（30/49）， and specificity was 58.62%（17/29）. The number of resection lesions was 13.00±8.16， the time of operation was （74.25±22.68） min. The average hospital stay was 1 d after surgery. The local hematoma occurred in 2 cases and no other complications occurred during one month of follow-up. Conclusions The guidelines of MMT protocoled according to clinical manifestation of breast cyst patients and imaging of high-frequency ultrasound in author’s department are simple and utility. Minimal excision and biopsy via MMT can confirm the histological type and help for early diagnosis of breast cancer and precancerous lesion. It is important and necessary to standardize the surgical indications of MMT in the clinical work.