超声内镜与胃镜在胃间质瘤临床诊断的对比分析

目的探讨超声内镜和胃镜在胃间质瘤的临床诊断价值。方法选取我院2013年1月~2014年11月初步诊断为胃间质瘤患者350例,其中行超声内镜检查175例,行胃镜检查175例,两组均行镜下病理活检,并比较两组检查结果的阳性率与病理结果之间的诊断符合率。结果超声内镜诊断阳性率为100%(175/175),胃镜诊断阳性率为97.14%(170/175),与病理结果的符合率为超声内镜的诊断符合率97.14%(170/175),高于胃镜诊断符合率的94.29%(165/175),但两者差异无统计学意义(P0.05)。结论超声内镜及胃镜诊断胃间质瘤各有特点,超声内镜诊断率高可作为胃间质瘤的术前首选检查。     

Magnetic resonance tomography in the diagnosis of breast tumors

A complete examination (mammography, ultrasonography and magnetic resonance tomography) has been made for 82 patients with breast masses. A high diagnostic efficacy of the dynamic contrast-enhanced MRT of the breast masses has been proved. The paper showed the advantages of dynamic contrast-enhanced tomography, as compared to mammography and US in cases with the small carcinomas developed on the background of the marked fibroadenomatous changes in the breast, in the dense or deformed glandular tissue, in cases of the postoperative scarring as well as with retromammary localization of the tumors.     

X-ray-ultrasonic parallels in tumors of the stomach and intestines]

Combined clinical, radio and ultrasound investigation of 46 patients was carried out. It was shown that routine transabdominal UTS could be employed in diagnosis of gastric and intestinal tumors but mainly at more advanced stages (T3, T4). Potentialities of the method were shown to depend, to a great extent, on a tumor site, growth, type, sizes, and spreading, as well as on the resolving power of an US diagnostic apparatus. The use of a high resolution apparatus made it possible to detect tumor invasion, but topography of a tumor was difficult to define. The x-ray or endoscopic method can be used as an adjuvant method of specified diagnosis of gastric and intestinal tumors.     

Fine-needle biopsy in the early diagnosis of thyroid neoplasms

Among the patients directed to the Department of Endocrinology of the Institute of Internal Medicine for diagnostic examinations of the thyroid, 726 (647 women and 79 men, of age between 16 and 79 years) were qualified to surgery after scintigraphic detection of cold nodules. From this group, 474 patients had thin-needle biopsy specimens taken for cytologic examination. The results of the latter examinations have been compared with those of histologic examination performed on the tissue removed during surgery. The occurrence of a malignant tumor (in 99.1%--thyroid cancer) was found in 108 patients (22.8%) from the group having thin-needle biopsy performed. Comparison of the results of cytologic examination with those of postoperative histologic examination demonstrated low sensitivity of biopsy examination (50.0%), as opposed to high specificity (96.2%) and high accuracy (85, 3%). Analysis of the false-negative results (54/108) revealed that the main causes of errors are difficulties in differentiation of adenoma from follicular carcinoma. Widening of the indications to surgery by a group of patients with adenoma will increase sensitivity to 84.8% and will require including into the operated group of about 50% of patients with scintigraphically diagnosed cold nodules: The introduction of the new term: "urgent strumectomy", has been proposed; also a diagnostic algorithm, useful for early diagnosis of malignant tumors of the thyroid, has been discussed.     

Cytodiagnosis of Hodgkin's disease in sputum specimens

In patients with histologically proven Hodgkin's disease, knowledge of the extent of involvement of lymph nodes and other organs has proven valuable in the determination of treatment and prognosis. One of the most common sites of involvement outside the hematopoietic system has been shown to be the lung parenchyma; in this study, six patients with a tissue-proven diagnosis of Hogdkin's disease and positive cytologic findings in the sputum were reviewed. Three cell types not found in normal sputum specimens were identified in these patients and were correlated with the histologic patterns of the tumors as seen in lung biopsies. Our results suggest the usefulness of sputum examination as an adjunctive or possibly a substitute diagnostic procedure in the evaluation of patients with Hodgkin's disease and possible lung involvement. They also suggest that in some cases the cytologic diagnosis can be quite specific in the identification of neoplastic cells as consistent with a diagnosis of Hodgkin's disease.     

Combined carcinoembryonic antigen and cytopathologic examination in ascites

OBJECTIVE: To investigate use of the combined carcinoembryonic antigen (CEA) test and cytopathologic examination to improve the diagnosis of neoplastic vs. nonneoplastic ascites. STUDY DESIGN: The tests were performed prospectively on 130 patients with ascites whose effusions were submitted for cytologic examination. RESULTS: Sixty-seven patients had epithelial tumors, and the cytologic examination was positive in 39 (58.2%). The CEA level was > or = 11.0 ng/mL in 36 patients (53.73%). CEA was helpful in the diagnosis in 18 cases, increasing to 57 (85.07%) the number of positive diagnoses. Eight samples of nonepithelial tumors had low levels of CEA. In 55 patients with nonneoplasic ascites the cytopathologic examination was negative, but the CEA assay was > 11.0 ng/mL in 3 patients. CONCLUSION: The cytopathologic examination should be performed in all cases, and the CEA assay should be done in suspected cases of epithelial neoplasia in which the cytologic examination was negative, there was uncertainty about the histologic type of neoplasia, or a diagnosis of nonepithelial neoplasia was made. When ascitic leukocytosis or hepatic failure is present, one should be cautious in interpreting the CEA assay because false positivity can occur.     

Fine needle aspiration of borderline ovarian lesions. Is It useful?

Borderline ovarian tumors are a low grade form of epithelial ovarian carcinoma with a low rate of growth and a low potential to invade or metastasize. According to the new World Health Organization classification, these tumors are placed between clearly benign and obviously malignant tumors because they exhibit some, but not all, of the morphologic features of malignancy. For a distinction between borderline lesions and cystadenomas or carcinomas, 2 criteria are of the utmost importance: presence of nuclear atypia and absence of stromal invasion. The pathologic subtype ofperitoneal implants is probably one of the main prognosticfactors in patients with serous tumors of low malignant potential, while the prognostic value of micropapillary serous carcinoma in patients with noninvasive implants remains debatable. Although fine needle aspiration (FNA) is the most accurate diagnostic method in cytopathology, its value in the diagnosis of borderline lesions is limited, mainly because of its inability to establish the absence of stromal invasion. The diagnostic accuracy of RNA can be improved by supplementing cytologic examination with such diagnostic techniques as immunocytochemistry and cytometry.     

Diagnostic value of cytology of voided urine

Cytologic examination of the sediment of voided urine is the only noninvasive method of detection, diagnosis and follow-up of tumors of the bladder and other anatomic components of the lower urinary tract. In order to assess the value of cytology of voided urine, we analyzed the diagnostic yield in 203 episodes, each composed of three sediments of voided urine obtained on consecutive days. For each one of these episodes, histologic material was available and was reviewed. Of special interest were 181 instances of primary or recurrent bladder tumors; in 37 of these patients, random biopsies of the bladder were also available for review. The concept of intraurothelial neoplasia (IUN), graded I, II or III, was introduced to describe degrees of atypia in flat urothelium, with IUN grade III corresponding to nonpapillary carcinoma in situ. The results documented that cytology of voided urine is highly reliable in the diagnosis of high-grade tumors, with a sensitivity of 94.2%. In primary flat carcinoma in situ (IUN III), the sensitivity was 100%. The method failed in the recognition of grade I papillary tumors and in about one-third of grade II tumors. There were no false-positive results in this study. In the 151 positive cases, the cytologic diagnosis was established on the first specimen in 79%, on the second specimen in an additional 14% and on the third specimen in 7% of cases. These results justify the use of three consecutive daily urine specimens for optimal diagnostic results. There is a remarkable similarity between the presence of cancer cells in voided urine and the DNA ploidy of bladder tumors, as established by Tribukait. The observations reported herein suggest that positive urine cytologies may correspond to aneuploid tumors and hence be not only of diagnostic but also of prognostic value. A direct proof of this hypothesis is under investigation; the results of this study justify the need for a field trial of an automated image analysis diagnostic system that was developed in this department.     

超声造影与增强CT鉴别诊断肾实质性恶性肿瘤的临床价值比较

摘要目的：比较超声造影（CEUS）和增强CT（CECT）鉴别诊断肾实质性恶性肿瘤的临床价值。方法：将93例肾脏肿瘤患者分别给予CEUS与CECT检查,将诊断结果与病理检查结果作对照,比较两种诊断方法的敏感度、特异度和准确率。结果：两种诊断方法的特异度无显著差异,P〉0．05;而CEUS对肾脏恶性肿瘤诊断的敏感度及准确率均显著优于CECT,P〈0．05。结论：CEUS在鉴别诊断肾实质性肿瘤方面较CECT在敏感度和准确率上具有一定的优势,临床上二者联合应用可优势互补,提高肾脏肿瘤的鉴别诊断价值。     

Role of fine needle aspiration cytology in the diagnosis of soft tissue tumours

Fine needle aspiration cytology (FNAC) is a widely accepted safe, simple and rapid diagnostic procedure used in the examination of neoplastic and non‐neoplastic lesions of various locations. Since its introduction, FNAC has developed into an effective diagnostic tool practiced in a large majority of medical centres evaluating and treating oncological patients. The role of FNAC has been limited in the examination of primary soft tissue lesions, however, as many physicians working in this area recommended against using FNAC. An increasing use of minimally invasive diagnostic procedures in the last decade has resulted in a better acceptance of FNAC as a first‐line approach or as a complementary tool to core needle biopsy in the diagnosis of musculoskeletal lesions. This review discusses the role and value of FNAC in the evaluation and treatment of soft tissue tumours based on the experience gathered over the course of 48 years at the Sarcoma Center in Lund, Sweden. FNAC reports most often provide diagnostic information allowing the initiation of treatment or, when definitive diagnosis cannot be rendered from a cytological examination, guiding the continued diagnostic investigation. The main advantages of soft tissue FNAC are good sensitivity and specificity, low morbidity, speed of diagnosis, and low cost/benefit ratio. The most important disadvantages stem from limited experience in cytological diagnosis of soft tissue tumours and a lack of standardised and uniform reporting system for soft tissue FNAC.     

双气囊小肠镜在小肠出血中的应用价值

目的:观察双气囊小肠镜在小肠出血中的病变检出率、病因诊断率、耐受性和安全性,并探讨双气囊小肠镜对小肠出血的内镜下治疗情况.方法:对2006年3月至2009年11月烟台毓璜顶医院消化内科收治的可疑小肠出血患者102例行双气囊小肠镜检查,首选进镜方式分为经口或经肛2种,首选方式检查后未发现病灶者,日后改换进镜方式再行检查.对活动性出血病灶行内镜下止血治疗,小肠息内行息肉切除.结果:双气囊小肠镜的病变检出率为94.12%(96/102),病因诊断率为84.31%(86/102).其中35例检查时见病变活动性出血,行内镜下止血治疗,33倒止血成功,内镜止血成功率为94.30%(33/35);在耐受性方面.双气囊小肠镜的耐受性依次为:全麻下经肛进镜、全麻下经口进镜、非麻醉经肛进镜、非麻醉经口进镜.所有患者均未发生严重并发症.结论:双气囊小肠镜对小肠出血具有较高的病变检出率和病因诊断率,并且可行内镜下止血治疗,是一项安全、有效的临床诊疗方法.     

Imaging diagnosis of schistosomiasis japonica--the use in Japan and application for field study in the present endemic area

For detecting lesions-related schistosomiasis japonica, X-rays, scintillation scanning, ultrasonography (US), computed tomography (CT), magnetic resonance (MR) and endoscopic examinations with biopsies have been used in Japan. Liver fibrosis and calcified changes are detected by US and CT. Most of the lesions that are detected by endoscopic examinations are due to deposited ova of Schistosoma japonicum. Portal hypertension is detected by US, CT and gastroscopic examination. Because schistosome infection decreased rapidly in Japan, most of the studies on imaging diagnosis were performed on chronic lesions or sequelae of schistosomiasis. Most of the techniques were used on admitted patients in well-equipped hospitals. US was introduced in the 1970s as a safe, rapid, non-invasive and inexpensive technique and has been used for diagnosis in hospitals and screening in the fields. As a typical US image of the liver, septal formation by high echogenic bands like mosaic was described, and this network pattern was reported in the other endemic countries; China and Philippines. As an appropriate technique, US has been broadly used in developing countries. Not only for diagnosis in a hospital, but also for monitoring changes of morbidity, US is used in the community level. Network pattern related to the severity of S. japonicum infection, has not been described in S. mansoni or S. haematobium infection. Appearance of network pattern depends on pathological changes such as periportal fibrosis, postnecrotic fibrosis and calcified ova. For advanced studies on morbidity of schistosomiasis japonica, further research on pathological basis of network pattern and standardization of US diagnosis are necessary.     

Diagnosis of Clostridium perfringens intestinal infections in sheep and goats

Clostridium perfringens produces disease in sheep, goats and other animal species, most of which are generically called enterotoxemias. This micro-organism can be a normal inhabitant of the intestine of most animal species including humans, but when the intestinal environment is altered by sudden changes in diet or other factors, C. perfringens proliferates in large numbers and produces several potent toxins that are absorbed into the general circulation or act locally with usually devastating effects on the host. History, clinical signs and gross post-mortem findings are useful tools for establishing a presumptive diagnosis of enterotoxaemia by C. perfringens in sheep and goats, although no definitive diagnosis of these diseases can be made without laboratory confirmation. Because all types of C. perfringens can be normal inhabitants of the intestine of most animals, culture of this micro-organism from intestinal contents of animals has no diagnostic value unless a colony count is performed and large numbers (usually more than 10(4)-10(7)CFU/g) of C. perfringens are found. The most accepted criterion in establishing a definitive diagnosis of enterotoxaemia by C. perfringens is the detection of its toxins in intestinal contents. However, some of the major toxins of C. perfringens (i.e. epsilon toxin) can also be found, albeit in small amounts, in the small intestine of clinically normal sheep, and this poses a diagnostic challenge. In such cases the histopathology of the brain must be used as an alternative diagnostic tool, since the lesions produced by epsilon toxin in the brains of sheep and goats are unique and pathognomonic for C. perfringens type D enterotoxaemia. Ancillary tests, such as measurement of urine glucose or observation of Gram stained smears of intestinal mucosa can be used and, although they have a presumptive diagnostic value when positive, they cannot be used to rule out a diagnosis of enterotoxaemia if they are negative. In conclusion, the diagnosis of C. perfringens infections in animals is complex and it is appropriate to rely on a combination of diagnostic techniques rather than one singe test.     

Clinical examination,xeromammography, and fine-needle aspiration cytology in diagnosis of breast tumours.

The diagnostic accuracy of clinical examination, xeromammography, and fine-needle aspiration cytology was compared with definitive histological findings in 255 breast lumps excised during one year. When suitable aspirates were obtained for cytological examination the diagnostic accuracy of aspiration cytology was higher than clinical examination or xeromammography. A diagnostic accuracy of 99% was achieved when all three screening tests were in agreement. As well as confirming a clinical diagnosis of malignancy, cytology is useful in identifying malignancy when clinical findings suggest that the tumour is benign. The availability of accurate cytology has affected patient management in many ways. Xeromammography did not enhance the diagnostic accuracy of clinical examination and aspiration cytology in patients presenting with a breast lump and, as a procedure with potential hazard, the benefit of routine xeromammography is questionable when an efficient cytological service is available.     

The usefulness of contrast-enhanced sonography in the differential diagnostic of adrenal tumors

INTRODUCTION: The occurrence of gland tumors causes significant clinical problem. Non hormone-secreting tumors provide the most complicated diagnostic difficulties. The application of contrast-enhanced sonography could improve the vessels visualization and point out characteristic features of benign and malignant changes. The authors believe that this new method make possible the differential adrenal tumor diagnostic process more precise and increase the specificity of ultrasonography in the recognition of benign and malignant tumors. The aim of this study was to define the usefulness of contrasting agent Levovist in differential diagnostics of adrenal tumors and its influence on sensitivity and specificity of ultrasound examination and to establish patients qualification criteria for surgical procedures. MATERIAL AND METHODS: Ultrasound examinations were made with the use of digital devise by GE Voluson 740, probe 4-6 mHz with Doppler options and volumetric probe 3D according to the following protocol: 26 patients with recognized adrenal tumor were qualified for the examination. Patients in the first stage of tumor vascularization had Doppler examination with color (CD) and power Doppler (PD). Three-dimensional ultrasonography was used to improve visualization of vascularization. In the final phase of the examination the patients were administrated of Levovist in the recommended by the producer dose: 2.5 g in the concentration of 400 mg/l. RESULTS: 26 cases of adrenal gland tumours were subjected to analysis. In standard ultrasonographic examination focal changes in 25 patients were hipoechogenic focuses and in one case the focus was hyperechogenic. Heterogeneity of focuses was observed in 16 cases. In Doppler examination with color (CD) and power Doppler (PD) vascular blood flow was revealed within 12. After using contrasting agent Levovist vascular blood flow was achieved in 4 additional cases, which constituted 61%. CONCLUSIONS: 1. 3D ultrasound could be useful in cases of big adrenal tumors--over 3 cm diameter after application of ultrasound contrast agents. 2. The use of Levovist in Doppler examination improves the visualization of tumor vascularization. However, it is impossible to differentiate benign from malignant tumors unequivocally.     

Accuracy of cytologic diagnosis of central nervous system neoplasms in sterotactic biopsies

The cytohistologic correlation is reported for 112 of the 128 consecutive sterotactic aspiration biopsies performed on patients with clinical and neuroradiologic evidence of brain tumors investigated at the Neurosurgery Department, Karolinska Hospital, from 1976 to 1979. The cytodiagnostic accuracy of benign and malignant tumors was 87% when adequate cell material was obtained. In 17 benign tumors of the sellar region, the diagnostic rate was 88%; cytologic examination independent of histologic biopsy is feasible in this area. The cytodiagnostic accuracy for 95 malignant central nervous system (CNS) tumors was 87% after adjusting for the appreciable sampling error inherent in the use of a stereotactic procedure during the early phase of the study. Two histopathologically proven infectious lesions were reported cytologically as benign. The main microscopic problems were the recognition of highly differentiated astroglial neoplasms and the differential diagnosis between poorly differentiated brain neoplasms and metastases to the CNS. Cytodiagnostic accuracy of CNS tumors can be increased by technical improvements in the stereotactic device, diagnostic experience and immunochemical staining.     

THE APPLICATION AND EVALUATION OF PERITONEOSCOPY

Peritoneoscopic examination has now been accepted throughout the world as a safe diagnostic procedure in lieu of laparotomy in selected cases.Laparotomies for diagnostic purposes alone should be condemned.Peritoneoscopy should not be done without a definite purpose and the procedure should not be expected to accomplish more than the purpose for which it is done. Indications for the procedure are set forth in detail. Experience has established definite contraindications, which are reviewed.The procedure is especially indicated for patients who are aged, emaciated, anemic, or poor surgical risks for any reason.All patients having ascites of undetermined cause should be examined by peritoneoscopy.The method is especially indicated for examination of patients with liver disease of all types, for pelvic examinations, for use to determine existence of ectopic pregnancy, and for tumor localization.Considerable use was made of the procedure during World War II to determine the extent and site of intra-abdominal injuries caused by crushing, explosions, and falls from high places.The procedure permits early and correct diagnosis, early decision as to the advisability of operation, and determination as to operability in cases of malignant gastric lesions. It is a safe method for obtaining biopsy specimens from intra-abdominal tissue and organs.Accuracy of diagnosis in cases in which the method can be used is considerably greater with peritoneoscopic examination than with clinical information alone.     

Dyspepsia: is a trial of therapy appropriate?

Dyspepsia is a common, benign condition that may be distinguished from gastroesophageal reflux, irritable bowel syndrome and pancreatobiliary, coronary or musculoskeletal disease by a careful history and physical examination. However, the presence or absence of a peptic ulcer in dyspepsia can be determined only by an endoscopic examination or a barium-contrast radiograph. Although the American College of Physicians has recommended trying drug therapy for patients with dyspepsia before diagnostic tests are done, new data support early diagnosis. Although therapy is initially cheaper than endoscopic examination, over a year the costs even out because most patients with dyspepsia eventually need an endoscopic examination, and many patients with nonulcer dyspepsia are given medication unnecessarily. Endoscopic examination, if available to general practitioners, is the most cost-effective approach to dyspepsia. An approach that does not include endoscopy lacks the opportunity to offer patients convincing reassurance that their illness is not serious, which is arguably the most important treatment in cases of nonulcer dyspepsia. Studies supporting the use of endoscopic examination predate the treatment of peptic ulcers with antibiotics, which makes an initial endoscopic examination to determine whether the patient has an ulcer even more important.