宫腔镜检查在诊断子宫内膜息肉中的价值分析

通过比较超声、宫腔镜检查与病理诊断子宫内膜息肉的结果,以及超声诊断结果阴性的病例中,宫腔镜与病理诊断的差异检出率,探讨宫腔镜检查对正确诊断子宫内膜息肉的重要性.回顾性收集连续在我院妇科行宫腔镜检查且证实子宫内膜息肉诊断的住院患者共730例.总结各病例超声诊断、宫腔镜检查及病理诊断的结果.统计分析显示,三者诊断子宫内膜息肉的检出率分别为82.7％、93.4％、90.8％.其中,由超声检查漏诊的子宫内膜息肉患者共126例,宫腔镜及病理检出率分别为96.8％、88.1％,且两者的阴性结果互不重叠,这种诊断差异在超声诊断结果示内膜增厚/内膜厚薄不均病例中尤为显著.因此,子宫内膜息肉的诊断方式中,宫腔镜诊断检出率最高,但仍有漏诊的病例由病理确诊,研究认为宫腔镜检查是确诊子宫内膜息肉的重要诊断方法.     

增殖期雌激素水平对经宫腔镜子宫内膜息肉电切患者术后子宫内膜厚度的影响

分析增殖期雌激素(E2)水平对经宫腔镜子宫内膜息肉电切(TCRP)患者术后子宫内膜厚度的影响。回顾性研究笔者所在医院妇科321例行TCRP治疗的患者资料。单因素回归分析显示:不同E2水平下TCRP术后宫腔恢复时间、排卵期内膜厚度及内膜形态的改变差异无统计学意义(P0.05);调整混杂因素行多因素分析显示:术后宫腔恢复时间、排卵期内膜形态改变差异无统计学意义(P0.05)。但排卵期内膜厚度随E2水平升高而增加,差异有统计学意义(P0.05)。因此,增殖期E2水平对TCRP术后患者排卵期子宫内膜厚度增加具有影响,有助于指导临床工作。     

卵巢子宫内膜异位症囊肿剥除术与卵巢功能

子宫内膜异位症是女性慢性盆腔痛和不孕主要病因,好发部位为卵巢、腹膜与阴道直肠膈.腹腔镜检查手术是诊断和治疗卵巢子宫内膜异位症的金标准.年轻未育的患者术后出现卵巢早衰,是近年来出现的新问题.本研究通过文献调查,分析各种预防和治疗卵巢早衰的可行措施.     

自动乳腺全容积成像在乳腺导管内癌诊断中的价值

探讨自动乳腺全容积成像(ABVS)在乳腺导管内癌诊断中的价值。收集手术病理证实的36例乳腺导管内癌患者资料,回顾性分析钼靶X线、常规超声及ABVS的影像表现。常规超声、ABVS及钼靶X线对病灶的检出率分别为63.16%、86.84%、84.21%,ABVS及钼靶X线检出率均高于常规超声,差异有统计学意义(χ~2值分别为4.34及5.68,P0.05)。ABVS能提高超声对乳腺导管内癌的检出率,有助于乳腺癌早期发现及治疗。     

原发性子宫颈腺癌和子宫内膜腺癌的鉴别诊断

采用组织阵列和免疫组化技术对39例子宫颈腺癌和20例子宫内膜腺癌进行Vimentin,CEA,ER,PR,CKs（7,19和20）,MUC antigen（1和5）和CD10抗体的检测。93％的黏液性宫颈腺癌表现为Vimentin和ER阴性,96％为PR阴性;20例子宫内膜样子宫内膜腺癌中,Vimentin阳性占90％,ER阳性占80％,PR阳性高达96％。CEA阳性率在宫颈癌中为81％,在子宫内膜样子宫内膜腺癌中有15％为灶状阳性表达。CD10在85％的子宫内膜腺癌组织的间质细胞中为阳性表达,仅有15％的宫颈腺癌表现为间质细胞染色阳性。MUC和CKs系列的蛋白表达未发现显著差异。     

原发性子宫颈腺癌和子宫内膜腺癌的鉴别诊断

采用组织阵列和免疫组化技术对39例子宫颈腺癌和20例子宫内膜腺癌进行Vimentin,CEA,ER,PR,CKs（7,19和20）,MUC antigen（1和5）和CD10抗体的检测。93％的黏液性宫颈腺癌表现为Vimentin和ER阴性,96％为PR阴性;20例子宫内膜样子宫内膜腺癌中,Vimentin阳性占90％,ER阳性占80％,PR阳性高达96％。CEA阳性率在宫颈癌中为81％,在子宫内膜样子宫内膜腺癌中有15％为灶状阳性表达。CD10在85％的子宫内膜腺癌组织的间质细胞中为阳性表达,仅有15％的宫颈腺癌表现为间质细胞染色阳性。MUC和CKs系列的蛋白表达未发现显著差异。     

经胸超声心动图对心脏占位性病变的诊断价值

为了探讨经胸超声心动图(TTE)对心脏占位性病变的诊断价值,本次研究回顾性分析241例经TTE诊断为心脏占位性病变患者的病例资料,并结合所有患者的手术病理或临床治疗结果进行对比分析。241例心脏占位性病变均经手术病理或临床证实,TTE对其中225例做出正确的病理类型提示,准确率为93.4%,TTE对各型心脏占位性病变的病理类型提示与手术病理或临床治疗结果的差异均无统计学意义(P0.05)。TTE可对心脏占位性病变做出初步的半定性诊断与鉴别诊断,且诊断准确率高,可作为心脏占位性病变的首选检查方法。     

超声造影引导下细针穿刺细胞学在判断乳腺癌腋窝淋巴结状态中的应用

研究经皮超声造影引导下细针穿刺细胞学检查评估乳腺癌患者腋窝淋巴结状态的可行性及应用价值。取2014年7月～2016年1月笔者所在医院收治的342例乳腺癌患者,术前行经皮超声造影引导细针淋巴结穿刺活检。以术后淋巴结病理结果为金标准评估细针病理结果。结果表明经皮超声造影引导下细针穿刺细胞学检查判断腋窝淋巴结状态的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率分别为97.57%(281/288)、100.00%(54/54)、100.00%(281/281)、88.52%(54/61)、97.95%(335/342)。经皮超声造影引导下细针穿刺细胞学检查可在术前准确评估乳腺癌患者腋窝淋巴结状态,细针穿刺细胞学病理阳性患者可避免前哨淋巴结活检,直接行腋窝淋巴结清扫术。     

卵巢子宫内膜异位症囊肿剥除术与卵巢功能

子宫内膜异位症是女性慢性盆腔痛和不孕主要病因,好发部位为卵巢、腹膜与阴道直肠膈。腹腔镜检查手术是诊断和治疗卵巢子宫内膜异位症的金标准。年轻未育的患者术后出现卵巢早衰,是近年来出现的新问题。本研究通过文献调查,分析各种预防和治疗卵巢早衰的可行措施。     

三阴性乳腺癌临床病理特征及预后回顾性分析

回顾三阴性乳腺癌(TNBC)病例,进行临床病理特征对比及预后分析.收集2005年1月至2006年12月在我院经手术治疗,经病理组织学确诊,并可随访到的348例乳腺癌病例资料,研究其临床病理特征,分析预后.结果TNBC多见于50岁以前未绝经女性,肿块＞2cm(72.2％)比例高于非三阴性乳腺癌(non-TNBC) 51.4％ (P＜0.05),复发转移率显著高于non-TNBC (P＜0.05).5年无病生存率(DFS),TNBC 62.8％低于non-TNBC 79.6％(P＜0.05).5年总生存率(OS),TNBC 73.6％低于non-TNBC 89.8％(P＜0.05).三阴性乳腺癌恶性程度高,转移复发率高,预后差,生存率低,其有效治疗方案需进一步研究.     

The diagnostic significance of auditory evoked brain stem potentials in multiple sclerosis

30 patients suffering from multiple sclerosis were examined by BERA among other audiological tests. In 47% we stated significant pathological BERA-latencies, in 53% pathological interpeak-intervals. The most patients have symptoms of brainstem, but 3 cases spinal symptoms. There are no constant correlations to subjective hearing threshold measurements. According to literature BERA, especially the measurement of interpeak-intervals, increases diagnostic security of the diagnosis multiple sclerosis.     

PTEN、p53和BAG-1在三阴乳腺癌中的表达及意义

为了研究PTEN、p53和BAG-1在三阴乳腺癌中的表达情况及临床病理意义,并讨论三者之间的关系.采用免疫组织化学SP法检测89例三阴乳腺癌中PTEN、p53、BAG-1的表达,其阳性表达率分别为44.9％、47.2％、73.0％,三者的表达均与患者的病理组织学分级、淋巴结转移情况有关（P＜0.05）.PTEN的表达与p53、BAG-1表达呈负相关;BAG-1与p53的表达呈正相关,提示三者在三阴乳腺癌中的表达存在一定关联性,临床上联合检测三者可能为TNBC预后评估、患者的个体化治疗提供一定的参考.     

Factor structure of the Penn State Worry Questionnaire: examination of a method factor

The Penn State Worry Questionnaire (PSWQ) was originally designed as a unifactorial measure of pathological trait worry. However, recent studies supported a two-factor solution with positively worded items loading on the first factor and reverse-scored items loading on a second factor. The current study compared this two-factor model to a negative wording method factor solution among college students. A method factor model with all PSWQ items loading on a single worry factor and reverse-scored items loading on a negative wording method factor provided as good a fit as the two-factor model. This method factor alone did not predict a generalized anxiety disorder diagnosis. Finally, the psychometric properties of an abbreviated scale containing only positively worded items were examined. The PSWQ appears to measure a single unitary construct, but response patterns differ between positively worded and reverse-scored items. Theoretical implications for pathological worry and assessment-related issues are discussed.     

动态磁共振成像在早期乳腺癌诊断中的临床研究

评价动态增强磁共振成像在早期乳腺癌诊断中的价值。随机选取2008年10月到2011年6月本院83例经B超或B超联合钼靶检查阴性的中青年女性行乳腺MRI检查,对MRI发现可疑结节病灶的患者进行手术活检,通过病理诊断来评价MRI在诊断早期乳腺癌的准确性和临床应用价值。83例中青年女性中,发现病变7例（8．4％）,癌前改变4...     

4例肾上腺区局限性Castleman病临床诊治分析

探讨肾上腺区局限性Castleman病的临床特点及诊治方法。回顾性分析4例经术后病理证实的肾上腺区局限性 Castle-man病患者的临床资料,并结合文献复习讨论Castleman病的临床特点及诊治方法。结果4例肾上腺区局限性Castleman病均顺利手术切除,术后随访1个月～22个月,未见肿瘤复发。Castleman病临床上少见,表现为不明原因的淋巴结肿大,临床表现无特异性,最终确诊依靠病理诊断。病变可发生在淋巴组织的任何部位,肾上腺区罕见,手术切除为首选治疗。     

Diagnosis and differential diagnosis of myasthenia gravis]

The author describes the possibilities of diagnosis and differential diagnosis of myasthenia gravis. The data is based on the literature and on case reports of personal observations of more than 270 patients with myasthenia. He inaugurates his own classification of myasthenia comprising of 8 types, among which there is one particular clinical type, described first by the author. The different problematic types of myasthenia are discussed together with the most important diagnostic tests and the principles of differential diagnosis. The clinical and pathological study is completed by illustrations.     

Teaching posttraining: influencing diagnostic strategy with instructions at test

It is believed that medical diagnosis involves two complementary processes, analytic and similarity-based. There is considerable debate as to which of these processes defines diagnostic expertise and how best to teach clinical diagnosis and reduce diagnostic errors. The purpose of these studies is to document the use of these strategies in medical students. We shifted the balance in use of these processes and improved diagnostic accuracy with instructions given posttraining at the moment of diagnosis. Analytic processing reflecting the degree to which cases contain the diagnostic rules was indexed by the rate of accuracy on typical versus atypical cases (typicality effect). Similarity-based processing reflecting the degree to which cases resemble previously encountered cases was indexed by the rate of accuracy on similar versus dissimilar cases (similarity effect). Two studies are presented illustrating that diagnosis involves the coordination of analytic and similarity-based processes and that differential instruction given at test shifts the balance in the use of these processes. Study 1 illustrated that participants adopting an analytic strategy exhibit a larger effect of typicality. Participants adopting a similarity-based strategy exhibit a larger effect of similarity. The diagnostic approach of students given no instructions was predominantly analytic. Dual instructions in which participants first employed similarity-based processing followed by the application of rules improved overall accuracy. Study 2 investigated two versions of dual instructions and illustrated that assessing a case with the rules of diagnosis first may inhibit the subsequent use of similarity-based reasoning. The implications for diagnostic expertise and pedagogy are discussed.     

Clinician race, situational attributions, and diagnoses of mood versus schizophrenia disorders

This research examined clinicians' consideration of situational factors in diagnostic decisions of mood vs. schizophrenia disorders among psychiatric inpatients from a low-income, African American community. Clinicians completed questionnaires describing their diagnostic decisions. Responses reflecting the usage of situational information were investigated. African American clinicians used situational information more than non-African American clinicians. However, this increased attention to situational information was not uniquely associated with a particular diagnostic decision for African American clinicians. In contrast, consideration of situational attributions by non-African American clinicians did increase the probability of a mood diagnosis. Logistic regression analyses suggested differential application of a diagnostic standard among African American and non-African American clinicians. Implications for enhancing the cultural sensitivity of diagnosis practices are discussed.     

超声造影鉴别卵巢癌与盆腹腔结核的意义

超声造影能显著增强显示微小血管的能力,并能进行特定区域的半定量分析,已广泛应用于肿瘤诊断的影像研究中。因缺乏满意的辅助检查方法,盆腹腔结核与卵巢癌的鉴别诊断极为困难。本文探讨是否能利用超声造影对肿瘤血管显示的优势,通过肿瘤与炎症血管生成差异来鉴别卵巢癌与结核,从而开创一条无创、准确且快速的诊断方法。     

The Eating Attitudes Test: validation with DSM-IV eating disorder criteria

The Eating Attitudes Test (EAT; Garner & Garfinkel, 1979) is one of the most widely used self-report eating disorder instruments. Originally developed to diagnose anorexia nervosa, it is often used in nonclinical samples where it has a high false-positive rate, which is likely due to changes in diagnostic criteria. Because the EAT has not been validated with Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria, we examined its criterion validity for discriminating between nonclinical women with and without an undifferentiated DSM-IV eating disorder diagnosis. We also examined differences in mean EAT scores among eating-disordered, symptomatic, and asymptomatic participants. Results show that the EAT has an accuracy rate of at least 90% when used to differentially diagnose those with and without eating disorders and that mean EAT scores differed among eating-disordered, symptomatic, and asymptomatic participants.