讳疾患者食管癌并发纵隔-支气管瘘误诊1例

1病历资料 患者,男,51岁。三周前因高热一天于外院拍胸部正、侧位片（图1,2）,报告“两肺纹理增粗”,经抗生素治疗两周无效,以“高热、咳嗽待查”并否认其他不适于1986年7约3日转我院,拍胸片正位片（图3）报告“两下肺炎症”,继续抗生素治疗一周仍无效。会诊会上放射科提出：患者首次胸部正位片可见中纵隔稍向两侧增宽（图1,箭）,右侧位片可见食管床中上段肿块,肿块前部与气管气柱后部重叠（图2,箭）,而发热两周后的胸部正位片（图3）中下肺出现斑片影的同时可见中纵隔增宽比首次胸片（图1）有所回归,考虑食管肿瘤先并发纵隔瘘、纵隔脓肿形成致高热及中纵隔影增宽（图1）,再形成纵隔支气管瘘致肺炎,纵隔脓肿得以减压而使中纵隔影增宽缓解。遂行食管造影证实食管中段高度狭窄梗阻伴左侧主支气管瘘（图4,箭）。追询病史,患者万分恐惧、艰难地说出高热前已有进行性吞咽困难3月余。     

动态数字摄影诊断早期食管癌

目的探讨早期食管癌的动态数字摄影诊断。方法回顾性分析经手术病理证实的早期食管癌动态数字摄影双对比食管造影照片。结果80例早期食管癌动态数字摄影双对比造影表现：（1）颗粒状充盈缺损;（2）食管偏心性狭窄;（3）粘膜扭曲、分叉;（4）食管双边影;（5）斑片状龛影;（6）局限性管壁增厚。结论动态数字摄影对早期食管癌的发现、定位、定性具有重要价值。     

以食管受压为主要X线症的胸内淋巴结结核(附3例报告)

在胸内淋巴结结核中气管旁与分叉部之林巴结结核在普通胸片中不易发现，只有优质的高电压及体层片方能显示。患者常以吞咽困难而就医，食管钡餐透视可见外在性压迫一食管外压征，为本病较为特征性X线表现，此法简便易行，现将我所遇到的3例加以报告和讨论。1临床资料树1：男性，25岁。既往曾患两上肺浸润型肺结核，近日自觉胸背痛，且逐渐加重，经摄胸部正位片发现右上纵隔略加宽。因吞咽困难及咽下后胸骨后疼痛而再次就诊。经食管钡餐透视及摄片示食管上段之右缘可见外在之弧形压迹，并被推压向左略有移位，诊断为右气管分淋巴结结核。后…     

胸片肺尖假结节的成因分析

目的探讨正位胸片肺尖及侧位胸片气管中的假结节影的成因及意义。方法随机抽取100例健康成人的正侧位胸片,正位片发现假结节者加照前弓位,侧位片发现假结节者加照斜位,所有发现假结节者均行CT扫描,并经透视观察,结合国外文献,对其X线表现进行回顾性分析。结果 100例胸片中,正位有16例显示假结节,前弓位消失,侧位正常;侧位3例显示假结节,斜位消失,正位正常;1例正位片显示左锁骨下动脉走行;所有阳性发现者(有假结节者)的CT扫描及透视观察均未发现病变。结论正侧位胸片上的假结节均是由主动脉弓分支所致。     

食管重复癌变一例

食管重复(先天性食管囊肿)为少见的先天性畸形。现报道因副食管恶变,继发食管癌一例如下。患者女性,40岁,来自牧区。因咽食困难,胸骨后堵塞伴疼痛,逐渐加重20天,于1986华就诊。患者曾于12年前在地方医院诊断为纵隔良性肿瘤。X线表现:胸部正侧位平片显示,肿块边界清楚,密度均匀的囊性阴影,位于后纵隔。向左肺野突出、纵隔向对侧移位。胸椎畸形。食管吞钡造影,见食管受压纡曲、囊腔内进入少量造影剂,可见     

肺癌误诊为食管平滑肌肉瘤1例

病例男性，56岁。因吞咽困难、胸骨后不适2个月，经外院上消化道造影和CT检查提示食管胸下段平滑肌肉瘤，于2001年3月27日入院。入院时只能进软食，无咳嗽、咯痰、咯血等呼吸道症状。有30年吸烟史，每日30—50支。查体：颈部双侧锁骨上淋巴结（-）。X片：双肺未见结节．侧位片提示下肺静脉水平肺野密度增高，边界不清，肺门不大，纵隔不宽，结合外院CT考虑为纵膈内肿瘤。食管造影：食管下段见长约5cm管腔狭窄区，局部粘膜规整，造影剂通过受阻，考虑外压件改变，     

肺部隐匿部位肺癌的CT诊断价值

目的：探讨对肺部隐匿部位肺癌的影像学检查方法及CT诊断价值。方法：对收集的28例隐匿部位肺癌进行回顾性分析,所有病例都不同的进行过正位胸片、正侧位胸片加透视下多轴位观察及CT扫描检查。结果：28例患者CT表现肺门肿块并阻塞性肺部改变者8例,其中直接征象为支气管的狭窄、梗阻、管壁增厚者6例;局限性肺气肿合并肺炎者1例;肺部肿块,具有分叶征、毛刺影、血管集束征阳性者12例,肿块伴有肺内多发结节样转移灶者1例;胸膜附近片状影或结节影,不同程度伴有胸膜凹陷或纵隔淋巴结肿大者6例。结论：肺部隐匿部位肺癌在常规正位胸片上未发现明显病灶者,应进行胸部侧位片以及透视下多轴位观察,高度怀疑隐匿部位病变存在可能者,必须作CT检查,不能明确定性者进一步支气管镜镜检或穿刺活检,以免耽误患者诊治,贻误病情。     

内支架结合放疗治疗食管癌瘘13例

临床资料 晚期食管癌并发食管气管瘘、食管纵隔瘘患者13(男8,女5)例,年龄51～83(平均61．8)岁．均经钡餐或碘水造影诊断并经病理证实．其中食管气管瘘7例,食管纵隔瘘4例,食管左支气管瘘2例．晚期食管癌性瘘9例,食管癌放疗中并发瘘2例,食管癌术后吻合口瘘2例．临床表现为进食后剧烈呛咳9例,低热、寒颤6例,持续性胸背痛4例,声音嘶哑1例,X线检查见食管中、重度狭窄伴气管瘘5例,纵隔瘘2例,左支气管瘘2例;食管中度狭窄伴气管瘘1例,纵隔瘘1例(放疗近半量后);食管吻合口梗阻伴气管瘘1例;食管胃吻合口线状狭窄伴纵隔瘘1例．13例均使用国产镍钛记     

食管癌的CT诊断

本文分析了４０例食管癌患者的ＣＴ表现，总结为以下几点：（１）管壁非均匀性增厚或软组织肿块的形成；（２）管腔不规则偏心性狭窄；（３）狭窄近端管腔扩张；（４）食管周围组织或脏器的受侵；（５）纵隔淋巴结增大；（６）远处转移。还就食管癌的ＣＴ诊断，分期及ＣＴ检查的临床应用价值进行了探讨，认为ＣＴ在显示纵隔淋巴结肿大转移，肿瘤与周围组织脏器有无浸润和远外转移方面，优于食管造影；在食管癌的分期诊断和帮助临床选择治疗方案、制定治疗计划有着重要作用。     

纵隔巨大节细胞神经瘤

节细胞神经瘤,来源于交感神经节,常见于肾上腺、纵隔、腹膜后等处。我院最近收治1例纵隔巨大节细胞神经瘤。报告如下。患者男,30岁。1986年6月17日因活动后气促9个月入我院胸外科治疗。入院后给予各种检查。胸部后前位胸X线照片发现双侧上中纵隔有巨大团块影,分叶状,相互重迭,向双肺突出,左侧更大;侧位片显示肿瘤占据前中后纵隔区域;切层片显示气管受压     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.