乳腺癌前哨淋巴结活检的临床研究

目的 :探讨染料法检测乳腺癌前哨淋巴结的意义。方法 :在肿瘤周围的 3、6、9、12点各注射亚甲蓝稀释液 1ml,2 0分钟后在同侧胸大肌外侧缘至腋窝方向寻找蓝染淋巴管至蓝染淋巴结 ,检出蓝染淋巴结后单独送病检。然后根据术前制订术式进行手术。结果 :36例检出前哨淋巴结 34例 ,成功率 94 4 % (34/ 36 ) ;前哨淋巴结无癌转移 2 2例中腋淋巴结有癌转移 2例 ,假阴性 14 3% (2 / 14 )。结论 亚甲蓝染料法检测乳腺癌前哨淋巴结价廉易行 ,有一定意义 ,但需更多病例证实。

肾病综合征60例CT引导下经皮肾穿刺临床病理分析

目的在CT引导下为患者行经皮肾穿刺并分析肾病综合征的临床病理。方法随机选取2013年5月—2015年6月于该院就诊的60例肾病综合征患者,在CT引导下为患者行经皮肾穿刺,对病理组织进行活检,并观察患者的临床病理情况。结果穿刺成功率是96.67%(58/60)、组织学准确率高达100%(60/60)、血尿发生率是11.67%(7/60),肾包膜下出血率是6.67%(4/60)。结论经皮肾穿刺法的优点是病人痛苦小,取材方便,恢复快,对病理结果肉眼就可以看得见,且安全可靠,临床具有较高的准确性。

1309例结核病临床病理活检回顾分析

回顾分析1309例结核病临床病理活检情况。方法 回顾性分析我院2020.01~2022.12期间收治的结核病患者1309例作为研究对象,均进行临床病理活检,对所有患者的年龄、发病率、好发部位进行分析。结果 2020~2022期间临床病理诊断为结核病例数呈逐年增长趋势,病理活检中肺内结核多于肺外结核。结论 通过分析我院2020~2022年间收治的1309例结核患者病理活检情况,发现结核患者病例数呈逐年增长趋势,病理活检中肺内结核多于肺外结核,为后续结核病例研究提供参考,进一步完善结核患者诊断标准。

Gastric polypoid lesions:Analysis of 150 endoscopic polypectomy specimens from 91 patients

AIM:To analyze gastric polypoid lesions in our patient- population with respect to histopathologic features and demographic,clinical,and endoscopic characteristics of patients. METHODS:Clinical records and histopathologic reports of patients with gastric polypoid lesions were analyzed retrospectively.All lesions had been totally removed by either endoscopic polypectomy or hot biopsy forceps.The histopathologic slides were re-evaluated by the same histopathologist. RESULTS:One-hundred and fifty gastric polypoid lesions were identified in 91 patients.There were 53(58 %)women and 38(42 %)men with a median age of 53(range,31 to 82)years.The most frequent presenting symptom was dyspepsia that was observed in 35(38.5 %)patients. Symptoms were mostly related to various associated gastric abnormalities such as chronic gastritis or H pylori infection rather than polypoid lesion itself.Polypoid lesions were commonly located in the antrum followed by cardia.Out of 150 lesions,80(53 %)had the largest dimensions less than or equal to 5 mm and only 7 were pedunculated.The frequencies of hyperplastic polyps,foveolar hyperplasia,and fundic gland polyps were 46 %,18 %,and 14 % respectively. We also detected gastritis varioliformis in 12 specimens, lymphoid follicles in 9,4 adenomatous polyps in 4,polypoid lesions with edematous mucosa in 4,inflammatory polyps in 3,and carcinoid tumor in 1.Adenomatous changes were observed within two hyperplastic polyps and low grade dysplasia in one adenoma.Histopathologic evaluation of the surrounding gastric mucosa demonstrated chronic gastritis in 72(79 %)patients and H pylori infection in 45(49 %). CONCLUSION:Hyperplastic polyps are the mbst frequently encountered subtype of gastric polypoid lesions.They are usually associated with chronic gastritis or H pylori gastritis.Contrary to the previous belief,they may harbour adenomatous changes or dysplastic foci. Therefore,endoscopic polypectomy seems as a safe and fast procedure for both diagnosis and treatment of gastric polypoid lesions at the same session.In addition, edematous mucosa may appear misleadingly as a polypoid lesion in some instances and it can be ruled out only by histopathologic examination.

Liver histology in ICU patients dying from sepsis:A clinico-pathological study

AIM:To determine end-stage pathologic changes in the liver of septic patients dying in the intensive care unit. METHODS: Needle liver biopsies obtained immediately after death from 15 consecutive patients with sepsis and no underlying liver disease were subjected to routine histological examination. Liver function tests and clinical monitoring measurements were also recorded. RESULTS: Liver biochemistries were increased in the majority of patients before death. Histology of liver bi- opsy specimens showed portal inflammation in 73.3%, centrilobular necrosis in 80%, lobular inflammation in 66.7%, hepatocellular apoptosis in 66.6% and cholan- gitis/cholangiolitis in 20% of patients. Mixed hepatitic/ cholestatic type of liver injury was observed in 6/15 (40%) patients and hepatitc in 9/15 (60%). Steatosis was ob- served in 11/15 (73.3%) patients affecting 5%-80% of liver parenchyma. Among the histological features, the presence of portal inflammation in liver biopsy was as- sociated with increased hospitalization in the ICU prior death (P = 0.026). CONCLUSION: Features of hepatitis and steatosis arethe main histological findings in the liver in the majority of patients dying from sepsis.

Renal biopsy practice:What is the gold standard?

Renal biopsy （RB） is useful for diagnosis and therapy guidance of renal diseases but incurs a risk of bleeding complications of variable severity, from transitory hae-maturia or asymptomatic hematoma to life-threatening hemorrhage. Several risk factors for complications after RB have been identifed, including high blood pressure, age, decreased renal function, obesity, anemia, low platelet count and hemostasis disorders. These should be carefully assessed and, whenever possible, correct-ed before the procedure. The incidence of serious com-plications has become low with the use of automated biopsy devices and ultrasound guidance, which is cur-rently the “gold standard” procedure for percutaneous RB. An outpatient biopsy may be considered in a care-fully selected population with no risk factor for bleed-ing. However, controversies persist on the duration of observation after biopsy, especially for native kidney biopsy. Transjugular RB and laparoscopic RB represent reliable alternatives to conventional percutaneous bi-opsy in patients at high risk of bleeding, although some factors limit their use. This aim of this review is to sum-marize the issues of complications after RB, assessment of hemorrhagic risk factors, optimal biopsy procedure and strategies aimed to minimize the risk of bleeding.

Renal biopsy:Still a landmark for the nephrologist

Renal biopsy was performed for the first time more than one century ago, but its clinical use was routinely introduced in the 1950s. It is still an essential tool for diagnosis and choice of treatment of several primary or secondary kidney diseases. Moreover, it may help to know the expected time of end stage renal disease. The indications are represented by nephritic and/or nephrotic syndrome and rapidly progressive acute renal failure of unknown origin. Nowadays, it is performed mainly by nephrologists and radiologists using a 14-18 gauges needle with automated spring-loaded biopsy device, under real-time ultrasound guidance. Bleeding is the major primary complication that in rare cases may lead to retroperitoneal haemorrhage and need for surgical intervention and/or death. For this reason, careful evaluation of risks and benefts must be taken into account, and all procedures to minimize the risk of complications must be observed. After biopsy, an observation time of 12-24 h is necessary, whilst a prolonged observation may be needed rarely. In some cases it could be safer to use different techniques to reduce the risk of complications, such as laparoscopic or transjugular renal biopsy in patients with coagulopathy or alternative approaches in obese patients. Despite progress in medicine over the years with the introduction of more advanced molecular biology techniques, renal biopsy is still an irreplaceable tool for nephrologists.

Gastric pseudolipomatosis, usual or unusual? Re-evaluation of 909 endoscopic gastric biopsies

Microvesicular pneumatosis intestinalis, also called 'pseudolipomatosis' for resembling fatty infiltration, is characterized by the presence of small gas voids in the gastrointestinal wall, especially in mucosa. These voids are not lined with epithelia. There are few reported cases about colon, duodenum and skin. Because there is only one case report about pseudolipomatosis in the stomach, we reevaluated 909 endoscopic biopsies taken from gastric corpus to check the presence of pseudolipomatosis. We determined pseudolipomatosis foci in 3 percent (n=27) of biopsies. In two cases there were pseudolipomatosis foci in endoscopic biopsies having otherwise normal histologic findings, while there were pseudolipomatosis foci in endoscopic biopsies of 25 patients with gastritis. H pylori was found in 85 % of biopsies having pseudolipomatosis foci. In this study, we presented some histopathologic characteristics of pseudolipomatosis seen in gastric mucosa.

The potential for liquid biopsies in the precision medical treatment of breast cancer

Currently the clinical management of breast cancer relies on relatively few prognostic/predictive clinical markers(estrogen receptor, progesterone receptor, HER2), based on primary tumor biology. Circulating biomarkers, such as circulating tumor DNA(ctDNA) or circulating tumor cells(CTCs) may enhance our treatment options by focusing on the very cells that are the direct precursors of distant metastatic disease, and probably inherently different than the primary tumor's biology. To shift the current clinical paradigm, assessing tumor biology in real time by molecularly profiling CTCs or ctDNA may serve to discover therapeutic targets, detect minimal residual disease and predict response to treatment. This review serves to elucidate the detection,characterization, and clinical application of CTCs and ctDNA with the goal of precision treatment of breast cancer.

Measurement of serum paraoxonase-1 activity in the evaluation of liver function

Paraoxonase-1 (PON1) is an esterase and lactonase synthesized by the liver and found in the circulation associated with high-density lipoproteins. The physiological function of PON1 seems to be to degrade specific oxidized cholesteryl esters and oxidized phospholipids in lipoproteins and cell membranes. PON1 is, therefore, an antioxidant enzyme. Alterations in circulating PON1 levels have been reported in a variety of diseases involving oxidative stress including chronic liver diseases. Measurement of serum PON1 activity has been proposed as a potential test for the evaluation of liver function. However, this measurement is still restricted to research and has not been extensively applied in routine clinical chemistry laboratories. The reason for this restriction is due to the problem that the substrate commonly used for PON1 measurement, paraoxon, is toxic and unstable. The recent development of new assays with non-toxic substrates makes this proposal closer to a practical development. The present editorial summarizes PON1 biochemistry and function, its involvement with chronic liver impairment, and some aspects related to the measurement of PON1 activity in circulation.

Clinicopathological features of minute pharyngeal lesions diagnosed by narrow-band imaging endoscopy and biopsy

AIM:To evaluate the utility of magnified narrow-band imaging(NBI) endoscopy for diagnosing and treating minute pharyngeal neoplasia.METHODS:Magnified NBI gastrointestinal examinations were performed by the first author.A magnification hood was attached to the tip of the endoscope for quick focusing.Most of the examinations were performed under sedation.Magnified NBI examinations were performed for all of the pharyngeal lesions that had noticeable brownish areas under unmagnified NBI observation,and an intrapapillary capillary loop(IPCL) classification was made.A total of 93 consecutive pharyngeal lesions were diagnosed as IPCL type Ⅳ and were suspected to represent dysplasia.Sixty-two lesions of approximately 1 mm in diameter were biopsied in the clinic,and 17 lesions with larger diameters were resected by endoscopic submucosal dissection(ESD) at the Hiroshima University Hospital.In addition to the histological diagnoses,the lesion diameters were microscopically measured in 45 of the 62 biopsies.Thirtyfour of the 62 biopsied patients received endoscopic follow up.RESULTS:Minute pharyngeal lesions were diagnosed in 93 of approximately 3000 patients receiving magnified NBI examinations at the clinic.Of the 93 patients with IPCL type Ⅳ lesions,80 were men,and 13 were women.Fifty-six were drinkers,and 57 were smokers.Two had esophageal cancer.Twenty-one lesions were located on the posterior hypopharyngeal wall,and 72 lesions were located on the posterior oropharyngeal wall.All 93 lesions were flat and showed similar findings in the magnified and unmagnified NBI examinations.Although almost all of the IPCL type Ⅳ lesions showed faint redness when examined under white light,it was difficult to diagnose the lesions using only this technique because the contrast was weaker than that achieved in the NBI examinations.Of the 93 lesions,only 3 had diameters greater than 2.1 mm.Sixty-two lesions of approximately 1 mm were biopsied in the clinic,whereas 17 larger lesions were treated by ESD at the Hiroshima University Hospital.Of the 79 pharyngeal lesions that were biopsied or resected by ESD,5 were histologically diagnosed as high-grade dysplasia,39 were diagnosed as low-grade dysplasia,and 39 were determined to be non-dysplastic lesions.There were no cancerous lesions.Histologically,abnormal cell size variations and increased nuclear size were observed in all of the high-grade dysplasia lesions,while the incidence of these findings in the low-grade dysplasia lesions was low.Of the 62 biopsied lesions,45 were microscopically measurable.The measured diameters ranged from 0.1 to 2.0 mm.The dysplasia ratios increased with the diameters.A follow-up endoscopic examination of the 34 biopsied patients found the rate of complete resection by biopsy to be 79%.The largest lesion in which complete resection was expected was a low-grade dysplasia of 1.9 mm in diameter.CONCLUSION:Minute pharyngeal lesions suspected to be dysplasia that are identified by NBI magnifying endoscopy should be biopsied to determine the diagnosis and further treatment.

Clinical profile of patients with advanced age and inflammatoric dilated cardiomyopathy on endomyocardial biopsy

Background Endomyocardial biopsy （EMB） is an important tool when patients with inflammatoric cardiomyopathy （DCMi） are evaluated. We aimed to assess the clinical profile of elderly patients with DCMi on EMB. Methods Retrospective study of all consecutive patients hospitalized from January 2007 to December 2011 with clinical suspicion of DCMi undergoing EMB. Patients with evidence of DCMi on EMB （Group 1 〉 70 years, n = 85; Group 3 〈 70 years; n = 418） were compared to patients of the same age group without evi- dence of DCMi on EMB （Group 2 〉 70 years, n = 45; Group 4 〈 70 years; n = 147）. Results Among 24,275 patients treated at our institu- tion during the study period, 695 had clinical suspicion of DCMi and underwent EMB; 503 （2.1%） patients had DCMi on EMB. There were more male patients in Group 1, mean age was 74 ~ 2.8 years, mean ejection fraction was 38% q- 14%. On presentation, signs of hemody- namic compromise （NYHA functional class IIUIV, low cardiac output/index, and low cardiac power index） were more frequent in Group 1. EMB revealed viral genome in 78% of the patients, parvovirus B 19 （PVB） was frequently encountered in both age groups （Group 1： 69.4% vs. Group 2： 59.6%）; detection of more than one viral genome was more frequent in Group 1 （21.2% vs. 11.2%; P = 0.02） whereas the extent of immune response was significantly lower in individuals with advanced age. Conclusions In patients 〉 70 years with DCMi on EMB signs of hemodynamic compromise, detection of multiple viral genomes together with an overall lower extent of immune response were more frequently observed.

Impact of an Active Pharmacovigilance Program in a Third-Level Clinic in Barranquilla, Colombia

The objective of this study is to assess the impact of APV （active pharmacovigilance） and PPV （passive pharmacovigilance） by detection of ADEs （adverse drug events）, through PIs （pharmaceutical interventions）. Authors have used observational pre-post intervention study. Dader methodology was used in 123 patients with data obtained from medical records and pharmaceutical interview. Detection of ADE was made by direct observation and laboratory tests, with statistical significance 0.05. In PPV, 47 ADEs were detected： nausea, vomiting, skin rash and skin redness. In APV, 100 ADEs are presented, similar to those described in the PPV, in which Dipyrone produced 26.2%. The causes of DRPs （drug related problems） were： probability of adverse events 36%, personal characteristics 30%, and dose regimen and/or inadequate duration 22%. Out of 127 PIs performed, 91.34% were accepted and resolved. The patient satisfaction rate was 82.7% for APV and doctor satisfaction 90.4% with high impact, surpassing the 80%. The impact of APV was 93.6% and 53% in PPV for PIs and ADEs. PIs were performed to the ADEs with a high percentage of accepted and solved ones. Evaluation of satisfaction of patients and doctors in APV had a high impact. The assessment of APV generated a high impact on compliance and PPV a low one.

Association among lifestyle, clinical examination, polymorphisms in CDH1 gene and Traditional Chinese Medicine syndrome differentiation of gastric cancer

OBJECTIVE:To explore the association among lifestyle,clinical examination,polymorphisms in CDH1 gene and Traditional Chinese Medicine(TCM)syndrome differentiation of gastric cancer(GC). METHODS:A hospital-based population of 387 GC patients was investigated in Jiangsu province.Relevant information regarding lifestyle and clinical examination were collected by a standard questionnaire.Four known single nucleotide polymorphisms(SNPs)in CDH1 were investigated by polymerase chain reaction-ligation detection reaction methods.Statistical analysis was conducted by SPSS 16.0 software.RESULTS:The results showed that meal duration and the status of glutamic pyruvic transaminase were significantly associated with TCM syndrome differentiation of GC(both P<0.05).None of the four SNPs in the E-cadherin(CDH1)gene achieved significant differences in their distributions among the nine syndrome types of GC(both P>0.05).However,significant differences were observed in rs13689 genotype distributions between several pairs of syndrome types of GC,suggesting that rs13689 is correlated with the syndrome differentiation of GC.CONCLUSION:Integrated analysis of lifestyle,clinical examination and CDH1 gene polymorphisms can contribute to a better understanding of the GC syndrome types and may improve the efficacy of interventions by stratifying disease according to TCM criteria.