Adenocarcinoma of the third duodenal portion: Case report and review of literature

We focus on the diagnostic and therapeutic problemsof duodenal adenocarcinoma,reporting a case and reviewing the literature.A 65-year old man with adenocarcinoma in the third duodenal portion was successfully treated with a segmental resection of the third part of the duodenum,avoiding a duodeno-cephalo-pancreatectomy.This tumor is very rare and frequently affects the Ⅲ and Ⅳduodenal portion.A precocious diagnosis and the exact localization of this neoplasia are crucial factors in order to decide the surgical strategy.Given a non-specificity of symptoms,endoscopy with biopsy is the diagnostic gold standard.Duodeno-ceph-alo-pancreatectomy(DCP) and segmental resection of the duodenum(SRD) are the two surgical options,with overlapping morbidity(27% vs 18%) and post operative mortality(3% vs 1%).The average incidence of postoperative long-term survival is 100%,73.3% and31.6% of cases after 1,3 and 5 years from surgery,respectively.Long-term survival is made worse by two factors:the presence of metastatic lymph nodes and tumor localization in the proximal duodenum.The two surgical options are radical:DCP should be used only for proximal localizations while SRD should be chosen for distal localizations     

直肠类癌的诊断与治疗

Objective To investigate the diagnosis and treatment of rectal carcinoid. Methods Clinical data of 16 patients of rectal carcinoids in our hospital from January 2000 to December 2009 were analyzed retrospectively. Related literatures were reviewed. Results Among the patients included, 11 cases(68.8%)suffered from hypogastralgia, 3 cases(18.8%)bloody stool, 3 cases(18.8%)defecation number increase. All the patients underwent enteroscopy. The average size in diameter of all the tumors was 8.8 mm. 81.3% of the tumors ≤10 mm in diameter. The average distance from tumor to anus was 6.8 cm and 87.5% of the tumors ≤8 cm in distance, Only 25% of all the cases were diagnosed preoperatively, most cases were diagnosed as other diseases and definitely diagnosed by postoperative pathology. 14 cases underwent operation as radical resection of rectal carcinoma, and 2 cases endoscopic removal. There was no operative death and postoperative five-year survival rate is 69.2%. Conclusions Preoperative diagnosis rectal carcinoid is difficult.Misdiagnosis rate is high. The key point of improving diagnosis of this disease is annal digital examination. Enteroscopy and pathology, operation is the first choice to treat rectal carcinoid.     

直肠类癌的诊断与治疗

Objective To investigate the diagnosis and treatment of rectal carcinoid. Methods Clinical data of 16 patients of rectal carcinoids in our hospital from January 2000 to December 2009 were analyzed retrospectively. Related literatures were reviewed. Results Among the patients included, 11 cases(68.8%)suffered from hypogastralgia, 3 cases(18.8%)bloody stool, 3 cases(18.8%)defecation number increase. All the patients underwent enteroscopy. The average size in diameter of all the tumors was 8.8 mm. 81.3% of the tumors ≤10 mm in diameter. The average distance from tumor to anus was 6.8 cm and 87.5% of the tumors ≤8 cm in distance, Only 25% of all the cases were diagnosed preoperatively, most cases were diagnosed as other diseases and definitely diagnosed by postoperative pathology. 14 cases underwent operation as radical resection of rectal carcinoma, and 2 cases endoscopic removal. There was no operative death and postoperative five-year survival rate is 69.2%. Conclusions Preoperative diagnosis rectal carcinoid is difficult.Misdiagnosis rate is high. The key point of improving diagnosis of this disease is annal digital examination. Enteroscopy and pathology, operation is the first choice to treat rectal carcinoid.     

成人先天性食管支气管瘘的诊断及外科治疗

目的 探讨成人先天性食管支气管瘘的临床诊断及外科治疗.方法 回顾性分析1990年5月至2010年8月确诊并手术的11例成人先天性食管支气管瘘患者的临床资料.其中男性7例,女性4例,年龄28～66岁,平均48.7岁.主要临床表现为间断咳嗽、咳痰10例,进流食呛咳6例,咯血6例,长期反复肺部感染伴低热4例,胸痛3例.病史5～36年,平均16.8年.本组患者术前均经食管造影,或同时结合食管镜、支气管镜检查证实为食管支气管瘘,术后病理进一步确诊.6例行右下肺叶切除术,1例行右中下肺叶切除术,3例行左下肺叶切除术,1例行左全肺切除术,瘘管的食管残端均经结扎、缝扎等处理.结果 10例术后痊愈出院,住院时间10～18 d,平均12.3 d.1例术后第8天发生食管瘘,经再次手术后治愈.术后11例患者均定期随访.3年生存率11/11,5年生存率9/11.结论 成人先天性食管支气管瘘临床少见,容易误诊,多体位食管造影是确诊的主要手段;外科手术是惟一的治愈方法.

Abstract：

Objective To explore the clinical characteristics, diagnosis and surgical treatment of adult congenital bronchoesophageal fistula. Methods Eleven cases of adult congenital bronchoesophageal fistula that were diagnosed and surgically treated between May 1990 and August 2010 had been reviewed.There were 7 male and 4 female patients, ranging in age from 28 to 66 years (mean 48. 7 years). The chief clinical presentation included coughing and sputum in 10 cases, recurrent bouts of coughing after drinking liquid food in 6 cases, hemoptysis in 6 cases, low fever in 4 cases, chest pain in 3 cases. The duration of symptoms before diagnosis ranged from 5 to 36 years ( mean 16. 8 years ) . The diagnosis of bronchoesophageal fistula was confirmed most by esophagography. Associated diseased lung was resected in all patients ( lobectomy in 10 cases and pneumonectomy in 1 case) . The operation included right thoracotomy in 7 cases and left thoracotomy in 4 cases. The fistula was completely resected in 10 cases. The tract was simply divided and the end was sutured in 1 case. Results The postoperative course was uneventful in 10 patients who were discharged from hospital 10 to 18 d after operation. One patient suffered from esophageal fistula and received second operation. Regular follow-up was conducted on all 11 patients,proving that 3-year survival rate was 11/11 and 5-year survival rate was 9/11. Conclusion Persistence of congenital bronchoesophageal fistula into adulthood is rare. The main symptom is nonspecific coughing and bouts of coughing after drinking liquid food. The most useful diagnostic method is the esophagography. Even though it is benign disease, life-threatening complications might occur and it must be treated surgically as soon as the diagnosis is established.     

美多巴治疗早期非创伤性股骨头坏死的近期疗效观察

Objective To observe the preliminary effects of the treatment for early non-traumatic osteonecrosis of the femoral head with Madopar. Methods Thirty-one patients with 48 hips of early stage (Ficat Ⅰ,Ⅱ) non-traumatic necrosis of the femoral head were treated with oral administration of Madopar since 2002. The disease was associated with consumption of alcohol in 16 cases with 27 hips; use of steroids in 10 cases with 13 hips; both consumption of alcohol and use of steroids in 2 cases with 4 hips; the remaining 3 cases, the condition was idiopathic. According to the criteria of Ficat et al., there were 4 hips in stage Ⅰ; 40 in stage Ⅱa and 4 in stage Ⅱb. Eighteen patients had received madopar for 10-28 months; 13 patients had been receiving the drug until now. Follow-up examinations were made by radiography, MRI and Charnley modified Merle d'Aubigne score. Results All patients were followed up for 12-84 months (average 27.8 months). The clinical symptoms improved in all cases. X-ray films showed that the bone density increased in nearly all the femoral heads, and 68.75%(33/48) of them maintained their shapes. The follow-up MRI showed their necrotic indices had decreased. The rate of clinical satisfaction was 91.67%(44/48), and the successful rate of treatment was 72.92%(35/48), and the collapse rate of early stage necrosis of the femoral head is 27.08%(13/48). Conclusion The preliminary results showed that madopar could prevent or delay collapse of the femoral head in early stage of osteonecrosis.     

美多巴治疗早期非创伤性股骨头坏死的近期疗效观察

Objective To observe the preliminary effects of the treatment for early non-traumatic osteonecrosis of the femoral head with Madopar. Methods Thirty-one patients with 48 hips of early stage (Ficat Ⅰ,Ⅱ) non-traumatic necrosis of the femoral head were treated with oral administration of Madopar since 2002. The disease was associated with consumption of alcohol in 16 cases with 27 hips; use of steroids in 10 cases with 13 hips; both consumption of alcohol and use of steroids in 2 cases with 4 hips; the remaining 3 cases, the condition was idiopathic. According to the criteria of Ficat et al., there were 4 hips in stage Ⅰ; 40 in stage Ⅱa and 4 in stage Ⅱb. Eighteen patients had received madopar for 10-28 months; 13 patients had been receiving the drug until now. Follow-up examinations were made by radiography, MRI and Charnley modified Merle d'Aubigne score. Results All patients were followed up for 12-84 months (average 27.8 months). The clinical symptoms improved in all cases. X-ray films showed that the bone density increased in nearly all the femoral heads, and 68.75%(33/48) of them maintained their shapes. The follow-up MRI showed their necrotic indices had decreased. The rate of clinical satisfaction was 91.67%(44/48), and the successful rate of treatment was 72.92%(35/48), and the collapse rate of early stage necrosis of the femoral head is 27.08%(13/48). Conclusion The preliminary results showed that madopar could prevent or delay collapse of the femoral head in early stage of osteonecrosis.     

Serious brain injury coexisting with multiple injuries caused by traffic accidents in 69 cases

Objective To explore the speciality,diagnosis,cure principle of serious brain injury coexisting with nultiple injuries caused by traffic accidents.Methods To analyze the clinic data of 69 cases of serious rain injury combined by oter parts of injuries caused by traffic accidents received from January 1998 to April 1999.Results This type of injury took up 11.5 percent of brain injuries in the same term and 33.6 percent of serious brain injuries.The specialities of the injury are that most of them were pedestrians crashed by vehicles.Coesisting injuries including chest injury and limb fractures accounted for a large part.The brain injury usally presented profound disturbance of consciousness,being dangerous and complicated,and a high ISS value.After treatment 13 cases died,9 cases was heavily crippled,11 cases lightly crippled,and 36 cases recovered.The death was usually caused by brain injury.Conclusions Road traffic accidents increased substantially every year.Most of them are related with violating drive rules and regulations.It is important to decrease the road traffic accidents by strengthening propaganda on traffic safety and traffic management.The main principles for salvage should emphasize the importance of pre-hospital emergency rescue and the accurate diagnosis rate,especially the distinction between coma and shock.The priority should be put on those injuries threatening to life.     

舒尼替尼治疗转移性肾癌的疗效和安全性分析:单中心37例总结

Objective To evaluate the efficacy and safety of sunitinib in the treatment of metastatic renal cell carcinoma (RCC). Methods A total of 37 patients with metastatic RCC were treated with between June 2008 and April 2010, including 28 males and 9 females. The median age was 52 (17-74) years. All patients received a pathologic diagnosis of RCC, which consisted of 1 papillary cell carcinoma and 36 clear cell carcinomas, 4 of which accompanied with partial sarcoma differentiation. Thirty cases were treated with first line therapy and 7 cases showed progression on first-line cytokine or sorafinib therapy. Sunitinib monotherapy was administered in repeated 6-week cycles of daily oral therapy for 4 weeks, followed by 2 weeks off in 34 patients, while another 3 patients received 37. 5 mg Qd continuously until disease progression or unacceptable toxicities occurred. Overall response rate and safety were evaluated. Results The median follow up was 12 months (8 cycles),range 1.5-19. 5 months (1-13 cycles). 26.5% (9/34) patients achieved partial responses, 70.6%(24/34) patients demonstrated stable disease over≥3 months and 1 (2. 9%) patient developed progressive disease. The objective response rate was 26.5%, and the disease control rate was 97. 1%.The 12 months' overall survival rate was 95.8% (23/24), and 12 months' progression-free survival rate was 62.5 % (15/24). The most common treatment-related adverse events were thrombocytopenia (30 cases, 81.1%), thyroid dysfunction (18/22, 81.8%) ,hand-foot syndrome (27 cases, 73.0%),neutropenia (23 cases, 62.2%) and hypertension (18 cases, 48.6%). The major grade 3 adverse events included thrombocytopenia (8 cases, 21.6%), hand-foot syndrome (4 cases, 10.8%) and diarrhea (2 cases, 5. 4%). Most adverse events were ameliorated by treatment interruption. Ten (27.0%) patients had dose decrement or drug discontinuation and 1 patient quit the treatment for intolerable fatigue. Conclusion The efficacy and manageable adverse event profile of sunitinib as a single agent in first- or second-line therapy for patients with metastatic RCC.     

舒尼替尼治疗转移性肾癌的疗效和安全性分析:单中心37例总结

Objective To evaluate the efficacy and safety of sunitinib in the treatment of metastatic renal cell carcinoma (RCC). Methods A total of 37 patients with metastatic RCC were treated with between June 2008 and April 2010, including 28 males and 9 females. The median age was 52 (17-74) years. All patients received a pathologic diagnosis of RCC, which consisted of 1 papillary cell carcinoma and 36 clear cell carcinomas, 4 of which accompanied with partial sarcoma differentiation. Thirty cases were treated with first line therapy and 7 cases showed progression on first-line cytokine or sorafinib therapy. Sunitinib monotherapy was administered in repeated 6-week cycles of daily oral therapy for 4 weeks, followed by 2 weeks off in 34 patients, while another 3 patients received 37. 5 mg Qd continuously until disease progression or unacceptable toxicities occurred. Overall response rate and safety were evaluated. Results The median follow up was 12 months (8 cycles),range 1.5-19. 5 months (1-13 cycles). 26.5% (9/34) patients achieved partial responses, 70.6%(24/34) patients demonstrated stable disease over≥3 months and 1 (2. 9%) patient developed progressive disease. The objective response rate was 26.5%, and the disease control rate was 97. 1%.The 12 months' overall survival rate was 95.8% (23/24), and 12 months' progression-free survival rate was 62.5 % (15/24). The most common treatment-related adverse events were thrombocytopenia (30 cases, 81.1%), thyroid dysfunction (18/22, 81.8%) ,hand-foot syndrome (27 cases, 73.0%),neutropenia (23 cases, 62.2%) and hypertension (18 cases, 48.6%). The major grade 3 adverse events included thrombocytopenia (8 cases, 21.6%), hand-foot syndrome (4 cases, 10.8%) and diarrhea (2 cases, 5. 4%). Most adverse events were ameliorated by treatment interruption. Ten (27.0%) patients had dose decrement or drug discontinuation and 1 patient quit the treatment for intolerable fatigue. Conclusion The efficacy and manageable adverse event profile of sunitinib as a single agent in first- or second-line therapy for patients with metastatic RCC.     

重症胰腺炎病死原因分析:附144例

Objective To explore the main causes for death due to severe acute pancreatitis (SAP) to improve the level of diagnosis and treatment. Methods The clinical data of 1162 SAP cases treated in our hospital from June 1997 to May 2005 were retrospectively analyzed. Among which, 144patients (12. 39%) died, 82(7.06%)abandoned treatment and 936(80.55%)were cured. Results the APACHE Ⅱ scores and pancreas Balthazar CT scores of the death group were higher than that of the survival group. The percentage of single one organ dysfunction and multiple organ dysfunction syndrome (MODS) was significantly higher in the death group than in the survival group. The mortality rate of SAP without obvious inducing factors was significantly higher than that of SAP with inducing factors. Conclusion Integrated traditional and western non-surgical treatment is effective for SAP.The treatment for SAP without obvious inducing factors is a challenge. The mortality rate of SAP is primarily related to the pathological changes of pancreas and the patient's general condition. Early diagnosis and treatment is important to decrease mortality rate and maintaining the function of important organs is basic to ensure curative effect.     

膀胱腺癌的诊断和治疗(附29例报告)

目的提高膀胱腺癌的诊断与治疗水平。方法29例中原发性膀胱腺癌18例，其中行全膀胱切除、尿流改道11例，膀胱部分切除7例；脐尿管腺癌9例，6例行扩大膀胱部分切除术，3例行全膀胱切除、尿流改道；印戒细胞癌2例，行全膀胱切除、尿流改道术。结果4例患者失访，25例患者随访时间为5个月一10年。生存1年者17例（64％），生存2年15例（60％），生存5年5例（20％），生存时间超过5年者均为早期患者。结论早期诊断、鉴别原发性膀胱腺癌与脐尿管腺癌、选择合适的手术方式是膀胱腺癌治疗的关键。     

膀胱腺癌的诊断与处理(附41例报告)

目的　提高膀胱腺癌的诊断与治疗水平。　方法　分析经手术病理证实的 4 1例膀胱腺癌患者资料。原发性膀胱腺癌 18例 ,作全膀胱切除 尿流改道 8例 ,膀胱部分切除 10例 ;脐尿管腺癌 12例中扩大膀胱部分切除 11例 ;转移性腺癌 11例均切除膀胱病灶。　结果　膀胱腺癌占同期膀胱癌的 3.2 %。 37例随访 5个月～ 10年 ,1年生存 19例 (5 1.3% ) ,2年生存 16例 (43.2 % ) ,5年生存 8例 (2 1.6 % )。　结论　原发性膀胱腺癌宜行根治性全膀胱切除术 ,脐尿管腺癌应作扩大性膀胱部分切除 ,对复发、转移性患者应采用综合治疗 ,以提高生存率     

膀胱腺癌的诊断与治疗(附21例报告)

目的：提高膀胱腺癌的诊治水平。方法：对1990年1月一2001年12月收治的21例膀胱腺癌患者临床资料进行回顾性分析，其中原发性膀胱腺癌18例，脐尿管癌3例。经尿道电切术3例，膀胱部分切除术9例，根治性全膀胱切除术8例，姑息性尿流改道术1例。结果：13例获得随访，1年生存率46．2％，5年生存率16．7％。结论：提高膀胱腺癌的早期诊断水平、严格术式选择、术后辅助放化疗有益于改善患者预后。     

原发性十二指肠肿瘤的诊断和治疗

目的 探讨原发性十二指肠肿瘤(PTD)的诊断和术式选择.方法 对北京丰台医院1995-2005年间52例PTD的诊断和手术治疗等临床资料进行回顾性分析.结果 术前行十二指肠镜检查42例,发现肿瘤38例(90.5%);行气钡双重造影40例,发现肿瘤32例(80%).良性肿瘤6例,均行十二指肠切开、肿瘤局部切除,术后5年生...     

原发性十二指肠肿瘤86例的诊断和治疗

目的:探讨原发性十二指肠肿瘤的诊断及治疗方法。方法:回顾分析26年间收治的86例原发性十二指肠肿瘤患者的资料，其中良性18例，恶性68例。诊断依赖于肠镜和影像学检查，治疗有赖于外科切除术。结果:临床表现包括胃肠道症状、胆道梗阻症状和非特异性的发热贫血及消瘦等。术前确诊率十二指肠镜为91.3％，气钡造影为88.5％，磁共振胰胆管造影为84.6％，B超为31.9％，CT为51.9％，磁共振为76.2％，ERCP为100%；联合十二指肠镜、气钡造影检查确诊率可达95.0％。71例发生于十二指肠降部。18例原发性十二指肠良性肿瘤全部被切除，5年生存率为92.3％；68例原发性十二指肠恶性肿瘤中35例行胰十二指肠切除，8例行十二指肠节段切除，切除率为63.2％；切除术后5年生存率为31.0％；25例行旁路手术，5年生存率为0。结论:原发性十二指肠肿瘤缺乏特异性症状，经内镜、气钡造影等联合检查，可提高术前阳性诊断率。对良性肿瘤可行十二指肠节段切除或局部切除，恶性肿瘤首选胰十二指肠切除术。     

原发性膀胱癌28例报告

目的：提高原发性膀胱腺癌的诊治水平。方法：回顾分析1983至2001年收治的28例原发性膀腺癌资料。结果：28例分别接受了6种手术治疗。26例获得随访，1a生存率88.5％，5a生存率38.5％。结论：认清膀胱腺癌的临床特点，做到早期诊断，早期广泛手术切除，联合放疗和化疗，可提高五年生存率。     

膀胱腺癌(附26例报告)

目的 提高膀胱腺癌的诊治水平。方法 回顾分析１９８０年１月至１９９８年１月收治的２６例膀胱腺癌资料。其中脐尿管腺癌１２例,原发性膀胱腺癌１４例。结果 ２６例中膀胱部分切除术８例,全膀胱切除＋尿流改道术１３例,根治性全膀胱切除＋尿流改道术２例,姑息性尿流改道术３例。随访１年生存率５２％,５年生存率２０％。结论 较局限的脐尿管腺癌可行广泛性部分膀胱切除术,原 性膀胱腺癌应行根治性全膀胱切除。     

气钡双重造影在结肠癌诊断中的应用价值

为探讨气钡双重造影在结肠癌诊断中的应用价值,回顾经气钡双重造影检查诊断为结肠癌的40例患者X线征象资料,并与手术及病理检查结果进行对比分析。结果显示,术后病理检查诊断,结肠癌39例,肠结核1例,气钡双重造影X线摄片诊断准确率为97．5％（39／40）;39例经病理检查证实为结肠癌的患者气钡双重造影X线摄片显示,肿瘤位于升结肠6例,肝曲8例,横结肠4例,脾曲2例,乙状结肠19例,与手术所见完全一致,准确率为100％。结肠癌气钡双重造影主要X线表现为软组织肿块、充盈缺损、腔内龛影、肠壁增厚、肠管狭窄、边缘僵硬、肠黏膜破坏中断。结果表明,气钡双重造影诊断结肠癌准确率高,而且操作简单、易于掌握,在基层医院具有较高的应用价值。     

非典型骨髓炎的影像学表现及治疗

目的 分析非典型骨髓炎的影像学表现探讨诊疗方法.方法观察24例非典型骨髓炎患者影像学表现,并与手术病理结果进行对照.结果 24例患者术后病理均证实为骨髓炎.显示软组织肿胀:X线平片10例,CT 18例,MRI 21例;显示骨膜反应:X线平片15例,CT 18例,MRI未见;显示骨髓腔密度增高:X线平片11例,CT 16例,MRI 24例;显示骨皮质增厚:X线平片10例,CT 14例,MRI 18例.结论 MRI对非典型骨髓炎的早期诊断、鉴别诊断帮助较大,X 线平片仍是基础.X线平片、CT结合MR检查是非典型骨髓炎的早期诊断和鉴别诊断的重要手段.非典型慢性骨髓炎影像学表现不典型,误诊、漏诊率较高,认识其临床及影像学表现可以提高诊疗水平.     

原发性十二指肠肿瘤的诊断和治疗

目的 探讨原发性十二指肠肿瘤的诊断和术式选择.方法 回顾性分析中国医科大学附属第一医院2001-2007年间124例原发性十二指肠肿瘤患者的临床资料,其中良性肿瘤10例,恶性肿瘤114例.结果 本组原发性十二指肠肿瘤常见的临床表现有上腹痛、黄疸、体重下降以及纳差等.肿瘤位于十二指肠球部9例(7.3%),降部107例(86.3%),水平部7例(5.7%),升部1例(0.8%).术前纤维内镜确诊率为90.5%,ERCP确诊率为94.1%,超声内镜确诊率为100%,胃肠气钡双重造影发现率为78.6%,MRI发现率为80.5%,CT发现率为75.7%,B超发现率为40.6%.10例原发性十二指肠良性肿瘤中5例行肿瘤局部切除术,2例行标准胰十二指肠切除术,1例行十二指肠节段切除术,2例未手术,5年生存率为100%;114例原发性十二指肠恶性肿瘤中47例行标准胰十二指肠切除术,3例行保留幽门的胰十二指肠切除术,5年生存率为35.8%;6例行局部肿瘤切除术,12例行十二指肠节段切除术,5年生存率为16.7%;22例行旁路手术,均死于术后5～16个月;2例行支架介入术,2例行经皮肝胆道穿刺引流术,死于术后3～11个月;其余未手术,死于术后1～11个月.结论 原发性十二指肠肿瘤缺乏特异性临床表现,经内镜、超声内镜以及ERCP等联合检查可提高术前诊断率.对良性肿瘤可行局部肿瘤切除术或十二指肠节段切除术,对恶性肿瘤首选胰十二指肠切除术,对晚期肿瘤患者可采用旁路手术以提高生存率及生存质量.