目的 探讨胰腺淋巴瘤和胰腺癌的鉴别诊断及治疗。方法 回顾性分析我院2000年1月至2008年4月期间经病理确诊的5例胰腺淋巴瘤患者的临床资料。结果 本组5例患者临床症状以腹痛、发热、黄疸为主，除1例外血浆CA19-9均正常，临床表现无法区分胰腺淋巴瘤和胰腺癌，CT等影像学有助于鉴别诊断。胰腺淋巴瘤CT增强扫描后均见强化表现，胰管不粗，和周围大血管关系紧密，邻近血管结构被推移，但无浸润、包绕现象。治疗以化疗为主，除1例失访外，其余4例分别存活24、14、14、13个月。结论 胰腺淋巴瘤是一种罕见的疾病，临床症状缺乏特异性，极易与胰腺癌混淆，治疗和预后却与胰腺癌不尽相同，临床上应该尽量通过CT或超声下穿刺明确诊断，以避免不必要的手术。
Objective To explore the value of virtual touch tissue quantification(VTQ) of acoustic radiation force impulse (ARFI) in the differential diagnosis between benign and malignant thyroid nodules. Methods The ultrasound (US), elastography imaging(EI), and VTQ of ARFI were performed to determine the characteristics and features of 63 thyroid nodules. The pathological diagnosis was the gold standard. According to the receiver operating characteristic curve (ROC) of US, EI, and VTQ, the critical points and diagnostic values of US, EI, and VTQ in diag-nosis of malignant thyroid nodules were achieved. Results Of the 63 nodules, 45 were benign and 18 were malignant. The area under curves of US, EI, and shear wave velocity(SWV) were 0.837(95% CI:0.712-0.962), 0.863(95% CI:0.751-0.974), and 0.900 (95% CI:0.810-0.990) respectively, and all the 3 kinds of technique had diagnostic value(P=0.001), but there were no significant difference among the 3 kinds of technique on the area under curve(P > 0.05). According to the receiver operating characteristic(ROC) curve, the critical point of US in distinguishing benign nodules with malignant nodules was 3 conventional ultrasonography, which displayed a sensitivity of 83.3%, a specificity of 86.7%, and a accuracy of 85.7%. The critical point of EI grades in distinguishing benign nodules with malignant nodules was gradeⅣ, which displayed a sensitivity of 94.1%, a specificity of 82.6%, and a accuracy of 87.3%. The critical value of SWV in distinguishing benign nodules with malignant nodules was 3.39 m/s, which displayed a sensiti-vity of 88.9%, a specificity of 91.1%, and a accuracy of 90.5%. Conclusion US, EI, and VTQ techniques all have diagnostic values in the differential diagnosis between benign and malignant thyroid nodules, and we should make combination with all of the 3 kinds of technique when performing differential diagnosis.
Hepatic angiomyolipoma (HAML) is a rare benign mesenchymal tumor of the liver, which has highly variable imaging appearances, often leads to missed diagnosis and misdiagnosis. The images of 2 patients with HAML confirmed by pathology were presented in this study, and the typical imaging features of the HAML, the underlying pathophysiological mechanism, and the differential diagnosis were briefly summarized so as to deepen the understanding of HAML and to improve the diagnosis and differential diagnosis abilities of HAML, then reduce the rates of missed diagnosis and misdiagnosis of the HAML.
Hepatic sinusoidal obstruction syndrome (HSOS) can be easily missed or misdiagnosed as Budd-Chiari syndrome in clinical practice. The authors displayed the imaging pictures of one patient with HSOS and made a brief description of typical imaging features, underlying pathophysiological mechanisms, and differential diagnosis of HSOS, with the hope of improving the understanding of HSOS and reducing the rates of leak diagnosis or misdiagnosis.
Objective To establish the overall diagnostic accuracy of the measurements of vascular endothelial growth factor (VEGF) for malignant ascites. Methods After a systematic review of current studies, sensitivity, specificity, and other measures of the value of ascites concentrations of VEGF in the diagnosis of malignant ascites were pooled by using random effects models. Qualified studies on evaluation of VEGF in diagnosis of malignant ascites in English and Chinese published from January 1990 to December 2009 were retrieved from The Cochrane Library, Cochrane Central Register of Controlled Trials, MEDLINE, EMbase, China National Knowledge Infrastructure (CNKI) databases, WanFang Data, and VIP Information. Two reviewers independently assessed the methodological quality of each study with the tool of QUADAS. Statistical analyses were performed by employing Meta-Disc 1.4 software. Meta-analyses of the reported sensitivity and specificity of each study and Summary Receiver Operating Characteristic (SROC) curve were performed. Results Seven studies met the inclusion criteria for the analysis. After testing the heterogeneity of the included studies, a random effect model was selected to calculate the pool weighted sensitivity and specificity with 95% confidence interval: the sensitivity was 0.81 (95%CI 0.75 to 0.85), the specificity was 0.90 (95%CI 0.86 to 0.94), the DOR was 50.45 (95%CI 28.37 to 89.73), and the AUC of SROC was 0.9507 (SE=0.013 0). The subgroups were analyzed to identify the sources of heterogeneity according to race and agent sources. There was homogeneity among the three studies with agents from Ramp;D company (χ2=0.05, P=0.9750; I2=0.0%), and the AUC of SROC were 0.9675 (SE=0.016 7). Conclusion VEGF has a highly accurate sensitivity and specificity with a b ROC curve, which makes it a new marker to differentiate malignant ascites from the benign.
Abstract： Sarcoidosis is a common systemic disease with noncaseating granulomatous epithelioid nodule and coexisting granulomatous inflammation. Although sarcoidosis can affect any organ of the body， more than 90% of the patients demonstrate thoracic involvement， which is often confusing with lung cancer and other diseases. Therefore, thoracic surgeons must have a clear understanding of sarcoidosis. Moreover， due to the special role of surgery in obtaining pathological specimens， thoracic surgeon plays an important role in the diagnosis and treatment of sarcoidosis. It is not difficult to make diagnosis for patients with typical clinical features of sarcoidosis. However， the majority of patients do not have specific manifestations of sarcoidosis. The cause of sarcoidosis remains unknown， and there is also no specific treatment strategy for it. But recent research has shown that annexin A11 gene may be involved in the pathogenesis of sarcoidosis， and tumor necrosis factor （TNF） inhibitor is effective in the treatwent of sarcoidosis.
Objective To evaluate the therapeutic effect of vitrectomy on bullous retinal detachment. Methods The clinical data of 7 patients (9 eyes) with bullous retinal detachment who had undergone vitrectomy due to useless photocoagulation were retrospectively analyzed. Bullous retinal detachment of the patients had been diagnosed by examination of slit-lamp microscope, three-mirror gonioscope, indirect ophthalmoscope, B-mode ultrasound, and fundus fluorescein angiography. All of the affected eyes underwent vitrectomy with closed triple incisions through the pars plana after release of subretinal liquid under the local anaesthesia. The cortex of vitreous body was taken out, and exsuction of subretinal liquid was carried out via retinal incision. Photocoagulation closed the incision and the effusion area of the retina, and intraocular filling matter was injected after exchange of air and liquid. The follow-up period lasted 3 months to 8 years with the average period of 47 months. Results Reattached retina was found in all of the affected eyes during the follow-up period. One eye underwent a second vitrectomy due to local retinal redetachment caused by a new retinal hole formed by the pull of pre-retinal proliferative membrane and a silicon vesicle entered the subretinal space, but the retina reattached after 1-year follow-up examination. The visual acuity impr oved in different degree after the operation in 8 eyes, but remained unchanged in 1 eye. Conclusion Vitrectomy for terminal bullous retinal detachment may promote the reattachment of retina safely and effectively, and save partial visual acuity of the affected eyes. (Chin J Ocul Fundus Dis, 2006, 22:299-301)