【Abstract】Objective To assess the value of 99Tcm-tetrofosmin imaging in discriminating malignant mass from benign breast mass.Methods From June 2000 to January 2002, 104 patients with breast mass detected by clinical examination were included. After 740 MBq 99Tcm-tetrofosmin was injected intravenously in the contralateral arm to the breast lesion, the front and the lateral images were collected in 5 min, 10 min and 20 min respectively. 99Tcm-tetrofosmin imaging localized in breast was defined as the positive sign of affinitive tumor. All patients underwent operation within one week. Using histological assessment as a golden standard, the sensitivity, specificity, positive and negative predictive value for 99Tcm-tetrofosmin SPECT of the breast were calculated respectively. Results The sensitivity of 99Tcm-tetrofosmin imaging for discriminating between malignant mass and benign mass in palpable breast lesions was 87%, specificity 84%, positive and negative predictive value were 85% and 86% respectively. Conclusion The results suggested that 99Tcm-tetrofosmin imaging is a valuable tool for distinguishing between malignant mass and benign mass in palpable breast lesions.
Thirty one cases of multiple primary colorectal carcinoma (MPCC) have been treated in our hospital since 1980, which account for 2.1%(31/1 450) of the patients with colorectal carcinoma in the corresponding period .Twentytwo of them were synchronous carcinoma and 9 cases metachronous carcinoma. Among the 31 cases there were 26 cases with two primary carcinomas, two cases with three primary carcinomas, 1 case with four primary carcinomas and two cases with five primary carcinomas. After reviewing the literature concerned , the author made an analysis of the incidence, the factors inducing MPCC takes place and the diagnosis and the treatment of the disease with emphasis on the discussion of the misdiagnosis and preventive measures.
ObjectiveTo investigate the diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice of elderly patients. MethodsTotally 338 patients with obstructive jaundice underwent ERCP were divided into elderly group (age ≥60 years old) and nonelderly group (age lt;60 years old) based on age. The levels of serum amylase (AMY), ALT, and TBIL in 6, 24, and 48 h after ERCP were detected. The success rate of cholangiopancreatography, accuracy rate of diagnosis, and incidence of complications after ERCP in two groups were analyzed. ResultsThe difference of serum AMY, ALT, and TBIL levels of patients in 6, 24, and 48 h after ERCP were not significant between two groups (Pgt;0.05). The success rate of cholangiopancreatography in nonelderly group was 96.3% (130/135) and in elderly group was 96.1% (195/203), and no difference was found (Pgt;0.05). However, the accuracy rate of diagnosis of ERCP in nonelderly group (84.6%, 110/130) was significantly lower than that in elderly group (98.5%, 192/195), Plt;0.05. The difference of the incidence of complications was not significant between two groups 〔14.8% (20/135) vs. 17.2% (35/203)〕, Pgt;0.05. There was no mortality in two groups patients. ConclusionERCP is a safe, effective, and accurate method, which is of importance to the diagnosis of obstructive jaundice in elderly patients.
Objective To improve the knowledge of bone marrow tuberculosis by summarizing the risk factors, clinical features, diagnosis, therapeutic response and prognosis. Methods The medical records of 62 patients with bone marrow tuberculosis from January 2004 to December 2014 were retrospectively analyzed. Results The patients included 34 males and 28 females. Their age ranged from 15 to 80 years with a mean age of 45.3±35.7 years. Among them, 21 cases (33.9%) had one or more risk factors such as advanced kidney disease or liver disease, chronic respiratory disease, rheumatoid immune system disease and diabetes. No specific clinical features were found in patients with bone marrow tuberculosis, and the most common symptom was fever (98.4%). Blood routine examination revealed that variety of hematological abnormalities include leucopenia, thrombocytopenia, anemia or pancytopenia occurred in 59 patients (95.2%). Chest CT scan showed typical disseminated tuberculosis in 22 patients (36.1%), secondary pulmonary tuberculosis in 6 patients (9.8%), and atypical manifestations of tuberculosis in 26 patients (42.6%). The common patterns of abdomen abnormalities on ultrasonic testing or CT scan were hepatosplenomegaly. Bone marrow biopsy was performed in all the 62 patients, among them, the needle-aspirated bone marrow specimens showed granulomatous lesions in 53 patients (85.5%). The acid-fast staining of bone marrow smear was performed in a total of 57 patients, which was positive in 28 patients (49.1%). Twenty-five patients completed phone call follow-up, and 8 patients died from bone marrow tuberculosis and its complications. Conclusions Bone marrow tuberculosis is a rare manifestation of disseminated tuberculosis. The common symptom of this disease is pyrexia . The clinical presentations and laboratory examinations of this disease are nonspecific. Bone marrow biopsy is a major method for diagnosis. Part of patients with bone marrow tuberculosis lack of imaging proof for lung lesion. Therefore, we should heighten vigilance for bone marrow tuberculosis in patients with fever of unknown origin.
ObjectiveTo sum up the diagnosis and treatment of adult ileal duplication with clinical cases from Peking Union Medical College Hospital (PUMCH). MethodsSix cases of adult ileal duplication admitted in our hospital from February 1996 to December 2010 were analyzed. Different assistant investigations were supposed to different patients due to the chief complaints including gastroscope, colonoscopy, abdominal CT scan, arteriography, 99Tcm radionuclide imaging, and double-balloon intestinal endoscope. None was made a definite diagnosis before operation with only one uncertain case. All cases received operation and pathological examination. Results All cases admitted were male. The chief complaints included intestinal bleeding, abdominalgia, intestinal obstruction, and abdominal mass. Five out of six patients received gastroscope, colonoscopy, and abdominal CT scan while three received mesenteric arteriography, but none was found any suggestion for ileal duplication. Even 99Tcm radionuclide imaging pointed out only two with abnormal abdominal bleeding. Three received doubleballoon intestinal endoscope, paying attention that only one discovered with ileal duplication. In a concluding, none was made a definite diagnosis before operation with only one uncertain case. All the cases received operation. The duplications of ileum in the length of 6-25 cm were found at the site of 11-100 cm proximal to ileocecum during the operation. Pathological report confirmed the clinical diagnosis of all cases with adult ileal duplications． Two cases were found with ectopic gastric mucosa, another two with diverticulum, and one with ectopic pancreas， in addition the remaining with inflammatory fibrous pseudotumor. Prognosis were good for all after operation. ConclusionsIleal duplications are rarely seen in adults, gender prefer male． Without specific clinical symptoms and inspections, definite diagnosis before operation is hard to make. But maybe doubleballoon intestinal endoscope and 99Tcm radionuclide imaging can give out positive result. Surgeons should be aware of this condition when performing abdominal exploration. Once discovered, resection is necessary.
Chronic lymphocytic leukemia (CLL) / small lymphocytic lymphoma (SLL) is a malignancy of mature B cells characterized by progressive lymphocytosis, lymphadenopathy, and splenomegaly. On February 21st 2019, with the accumulating of new data, the National Comprehensive Cancer Network updated the guideline for CLL/SLL. This article aims at providing a reasonable interpretation of the most important messages conveyed in the guideline.
ObjectiveTo explore the diagnosis and treatment features of parathyroid carcinoma (PTC). MethodsThe clinical data of 7 cases of parathyroid carcinoma treated from January 1993 to April 2014 were analyzed retrospectively. ResultsAll of the 7 patients had symptoms of hyperparathyroidism. Four patients had palpable neck mass. The average serum calcium level of preoperation was 3.07 mmol/L (2.35-4.98 mmol/L). The average parathyroid hormone (PTH) level was 1 181.5 pg/mL (78.4-2 061.7 pg/mL), which elevated 17 times the upper limit of normal. One case had operation in other hospital and six cases in Jishuitan hospital. The tumors located in the left inferior parathyroid gland in 3 cases, 2 cases of right lower parathyroid, and right superior parathyroid gland in 1 cases. One case underwent parathyroidectomy, parathyroidectomy including ipsilateral thyroid lobe or part of it was performed in 5 cases. Of 5 cases, 1 case was added central compartment lymphadenectomy. Three cases of postoperative tumor recurrence underwent reoperation, of which 1 case recurred 3 times. Two cases died. The remining 5 had survived until now, had survived for 5 years in 3 cases. ConclusionsA comprehensive approach with clinical presentation, serum calcium and PTH levels, B-ultrasonography, 99Tcm-MIBI, intraoperation aberrant findings, and histopathology offers help to accurate diagnosis of parathyroid carcinoma. Surgery is en bloc resection of the primary lesion. Recurrence needs reoperation, and long-term follow-up is advised.
ObjectiveTo observe the clinical features, treatment and prognosis of ciliary body tumors. MethodsA retrospective clinical study. From November 2011 to March 2023, 8 cases (8 eyes) with ciliary body tumours confirmed by pathohistological examination at the Department of Ocular Oncology, Beijing Tongren Hospital were included in the study. Patients' age, gender, involved eyes, symptoms, best corrected visual acuity (BCVA), intraocular pressure, cataract, lens subluxation, and imaging manifestations were collected in detail. All affected eyes were treated surgically. The follow-up time after surgery ranged from 1 to 10 years. The patients' clinical presentation as well as imaging, pathohistological features and treatment and prognosis were analysed retrospectively. ResultsAmong 8 cases (8 eyes), there were 3 males (3 eyes) and 5 females (5 eyes), 3 and 5 eyes in the right and left eyes, respectively. The median age was 44 years. Ciliary body medulloepitheliomas, melanoma, squamous cell carcinoma, leiomyoma, schwannoma, and adenoma of the nonpigmcnted ciliary epithelium were in 2, 2, 1, 1, 1, and 1 eyes, respectively. All reported decreased or loss of vision. Cataract, vitreous opacity, red eye and or (ocular pain), retinal detachment, lens subluxation, and secondary glaucoma were 6, 4, 4, 2, 1, and 1 eyes, respectively. Diagnostic imaging was consistent with pathological findings in 3 eyes. The first surgery was performed for enucleation and orbital implantation in 2 eyes, the patients were 9 and 10 years old with medullary epithelioma; the follow-up time after surgery was 1 and 5 years, respectively. Local tumour resection was performed in 6 eyes. Among them, 3 eyes with benign tumours were followed up for 1 to 9 years after surgery; 2 eyes showed significant improvement in visual acuity, 1 eye with adenoma of the nonpigmcnted ciliary epithelium had a preoperative BCVA of finger count/1 m, and a postoperative BCVA of 0.5, and 1 eye with leiomyoma had a preoperative BCVA of 0.06, and a postoperative BCVA of 0.5; and 1 eye was lost to follow-up. Malignant tumour in 3 eyes, of which 2 eyes recurred after surgery. Re-operation for enucleation and local tumour excision combined with local cryotherapy in 2 eyes of recurrence were 1 eye each, respectively. The follow-up period after surgery was 2 and 4 years, respectively. No recurrence after surgery in 1 eye, but there was no significant improvement in visual acuity during follow-up. No recurrence or metastasis was observed in any of the eyes during the follow-up period or at the final follow-up.ConclusionsCiliary body tumour types and clinical presentations are complex and varied; imaging can detect tumours but is poor at determining the nature of the lesion. Benign tumours do well with local excision surgery; malignant tumours do well with enucleation.
In order to investigate the possible involvement of the antigen CA50 in patients with colorectal carcinoma， the carbohydrated antigen CA50 in serum was examined in 30 normal individual， 27 patients with benign colorectal diseases and 66 patients with colorectal carcinoma by immunoradiometric assay (IRMA). The results showed that the serum CA50 in patients with colorectal carcinoma was significantly higher than that in patients with benign colorectal diseases and normal individual (Ｐ＜0.01). It was significantly declined after radical operation (Ｐ＜0.01). However， no significant change was noted after palliative operation (Ｐ＞0.05) and elevation was noted in patients with tumor recurrence. The results suggest that the measurement of serum CA50 may be an useful marker for diagnosis and prognostic evaluation in patients with colorectal carcinoma.
ObjectivesTo evaluate the predicting value of bedside pulmonary ultrasound in bronchopulmonary dysplasia (BPD) in premature infants.MethodsPremature infants with gestational age below 28 weeks or birth weight below 1 500 g admitted to NICU of Chengdu Women and Children’s Central Hospital from June 2018 to June 2019 were included. Pulmonary bedside ultrasound monitoring was performed on the 3rd, 7th, 14th and 28th day after admission, and the characteristic ultrasound images were recorded and scored. BPD were diagnosed by NICHD standard. The clinical data and pulmonary ultrasound data were compared and analyzed. Then diagnostic value of bedside pulmonary ultrasound in BPD of premature infants were analyzed.ResultsA total of 81 children involving 32 BPD and 49 non-BPD were included. The sensitivity (Sen), specificity (Spe) and area under curve (AUC) of receiver operating characteristic (ROC) of the "alveolar-interstitial syndrome" within 3 days after birth and the "fragment sign" on 28 days after birth were 81.25%, 51.02%, 0.66 and 31.25%, 97.96%, 0.65, respectively. The lung ultrasound scores in the BPD group on the 3rd, 7th, 14th, and 28th day after birth were 71.99.%, 68.39%, 0.71; 87.50%, 57.14%, 0.72; 78.13%, 73.47%, 0.76 and 56.25 %, 75.51%, 0.66. Sen, Spe and ROC AUC of comprehensive evaluation of lung ultrasound predicted the occurrence of BPD been 81.25%, 63.27%, and 0.85.ConclusionsThe comprehensive evaluation of combination of "alveolar interstitial syndrome" image characteristics within 3 days after birth, "fragment sign" image characteristics after 28 days, and lung ultrasound score at different times after birth can predict the premature infants with bronchopulmonary dysplasia.