Diagnosis of intrathoracic masses by transesophageal color Doppler echocardiography.

OBJECTIVE To evaluate the value of transesophageal color Doppler echocardiography in the diagnosis of intrathoracic masses.

METHODS Twenty patients with intrathoracic masses were examined by transesophageal echocardiography (TEE), including 12 patients with central lung masses and 8 with mediastinal masses. The neoplasms were explored by two-dimensional realtime ultrasonography, Doppler color flow imaging (DCFI) and pulsed Doppler (PD). The results were compared with computed tomography (CT), operative and pathological examination findings.

RESULTS We were able to identify the size, structure (solid or cystic), anatomic relationship, metastatic lymph nodes and venous carcinoembolus of the masses. Furthermore, the hemodynamic data in the vasculature inside the masses were detected.

CONCLUSIONS As a new method, TEE with Doppler technique is not only valuable in differentiating malignant and benign neoplasms but also useful for preoperative evaluation of the mass resectability in patients with intrathoracic neoplasms.

     

Collaborative study on evaluation of immunodiagnostic assays in schistosomiasis japonica by treatment efficacy assessment. Collaboration Group.

OBJECTIVE This paper is the summary of "National Symposium on the Value of Immunodiagnostic Assays in Schistosomiasis by Treatment Effects Assessment" which was directed by the Expert Advisory Committee for Schistosomiasis of the Ministry of Public Health. This symposium was held to evaluate the diagnostic effects of the new system of detection in the sensitivity and specificity by treatment assessment.

METHODS Twelve laboratories with 14 assay systems participated in this collaborative study, in which, 450 sera were detected by double blind trial using a classical antibody detection with ELISA as a control.

RESULTS The results showed that 6 test systems were superior or close to the classical antibody detection, especially in evaluating the value of treatment effects.

CONCLUSIONS It is unanimously recognized that much progress has been made in the research of immunodiagnosis of schistosomiasis in China, but many problems remain to be solved and worth further studying.

     

Microsurgery of intramedullary cervical cord tumor.

OBJECTIVE To evaluate whether intramedullary tumor of the cervical spinal cord is amenable to aggressive surgery and to clarify surgical timing and important points for tumor removal.

METHODS Fifty-eight patients with intramedullary tumor of the cervical spinal cord were examined by magnetic resonance imaging and treated by microsurgery in Huashan Hospital between May 1988 and December 1994. The results were analysed by F or Chi square tests.

RESULTS Tumors were totally resected in 50 cases (86.2%), subtotally resected in 7 and partially resected in 1. Forty-five (77.6%) patients had their neurological status improved postoperatively. Most patients with moderate neurological deficit can recover remarkably after total tumor removal. Laser surgery is especially helpful for treating lipoma.

CONCLUSIONS Intramedullary tumor of the cervical spinal cord is amenable to total tumor removal. Operation is suitable when a patient presents moderate neurological deficit. Proficient surgical technique and standards for total tumor resection are essential for good results. Preoperative radiotherapy contributes to difficult surgery and poor prognosis, and is not recommended.

     

Effect of TNF-alpha and IFN-alpha on the proliferation and cytotoxicity of lymphokine-activated killer cells in patients with bladder cancer.

OBJECTIVE To investigate the effects of interleukin-2 (IL-2) combined with either tumor necrosis factor-alpha (TNF-alpha) or alpha-interferon (IFN-alpha) on the proliferation and cytolysis to bladder tumor cells of lymphokine-activated killer (LAK) cells in patients with bladder cancer.

METHODS LAK cells were generated by ficoll-paque density-centrifugation from 21 patients with bladder cancer and cultured in medium containing IL-2. LAK cell proliferation was assayed in the presence of various concentrations of either TNF-alpha or IFN-alpha by cell count in 96-well plates. Bladder cancer cell lines BIU-87 and EJ were cultured as target cells and the cytotoxicity of LAK cells was determined by 3-(4,5-dimethylthiazol-2-yl)-2, 5 diphenyltetrazolium bromide (MTT) assay.

RESULTS The proliferation of LAK cells induced by IL-2 was enhanced by TNF-alpha in a dose-responsive fashion. The direct growth support for the LAK cells was also observed with IFN-alpha at the concentration of 1000 U/ml after 48 hours of culture. TNF-alpha (5000 U/ml) resulted in an increase in the cytotoxicity of LAK cells to BIU-87 and EJ cells. However, the change of cytotoxicity of LAK cells treated with IFN-alpha was not statistically significant.

CONCLUSIONS TNF-alpha and IFN-alpha enhance the proliferation and activation of LAK cells and influence their antitumor cytotoxicity in patients with bladder cancer.

     

Cataract extraction and intraocular lens implantation with anterior vitrectomy in children.

OBJECTIVE Extracapsular cataract extraction (ECCE) with selective intraocular lens (IOL) implantation has been the choice of the treatment for children with cataracts. With regard to surgical technique, ECCE with anterior segment vitrectomy has shown some success in reducing complications. Formation of a secondary membrane and opacity of the posterior capsule, however, are still major postoperative complications. To reduce these complications, we modified current surgical procedures with minimal incisions and manipulations.

METHODS ECCE with anterior segment vitrectomy was performed using Storz Protage's system in 84 eyes of 58 children ranging in age from 14 months to 14 years. Of 70 eyes of children aged above 3 years, IOLs were implanted simultaneously. Vision improvement and incidence of postoperative complications were compared with other standard procedures to determine the benefits of the operation for children with cataracts. After the anterior capsule was opened by continuous circular capsulorhexis or envelope-form capsulectomy, the lens cortex was excised. Subsequently, the IOL was implanted into the bag.

RESULTS Nine-30 months follow-up showed that all of the central area of the posterior capsule remained clear except one eye in which a secondary membrane was partially formed on the anterior surface of vitreous. No other operative or postoperative complications occurred.

CONCLUSIONS The results indicate that the modified procedure is beneficial in the prevention of secondary cataract formation and other postoperative complications in a short term follow-up, however, a long-term follow-up is warranted to evaluate its role in pediatric cataract surgery.

     

Experimental and field studies on some biological characteristics of Plasmodium vivax isolated from tropical and temperate zones of China.

OBJECTIVE To clarify some biological behaviors of Plasmodium vivax including the periodical infectivity of gametocytes for mosquitoes, the prepatent period, the incubation period, the relapse patterns and their relationship.

METHODS Laboratory reared Anopheles sinensis were fed through fetal membrane on blood from patients naturally infected with vivax malaria. After feeding at different hours, the engorged mosquitoes kept in the insectarium were dissected 5-7 days later. The percentage of mosquitoes infected and the mean number of oocysts per gut were taken as criteria of the viability of the gametocytes. The healthy volunteers artificially infected by mosquito bite or quantitative inoculation of sporozoites were treated with 1.5 g chloroquine base alone before and after the first and subsequent onset of fever to detect the natural course of disease in human body.

RESULTS The infection in mosquitoes can readily be divided into upward, peak, downward and non-infective period. The infectivity reached a peak at interschizogony period and fell to low level at the time when schizogony occurred. The short incubation period was frequently observed in persons bitten by 10 infected mosquitoes or 10 000 sporozoites inoculated and the long incubation period was constantly recorded in cases receiving 100 sporozoites. When one mosquito was allowed to feed on volunteers or 1 000 sporozoites were injected, the incubation period may be short or prolonged.

CONCLUSIONS The 48-hour cycle in the infectivity of gametocyte for mosquitoes was demonstrated and the peak of oocyst production preceded the peak of parasitaemia by 1 to 3 days. Prompt radical treatment is extra important. Since the incubation period is variable depending on the number of sporozoites inoculated and the tropical versus temperate zone malaria is not all-inclusive, the classification of tertian malaria might be reconsidered.

     

A cytogenetic study of 514 Chinese couples with recurrent spontaneous abortion.

OBJECTIVE To study the role of chromosomal aberration in the causation of recurrent spontaneous abortion (RSA) in Chinese population.

METHODS A total of 514 Chinese couples with 2 or more spontaneous abortions at less than 24 weeks of gestation were included. For each proband, a minimum of 13 metaphases were analyzed by G-banding. Additional cells (usually 50-100 cells) were screened when mosaicism was suspected. Chi 2 test was used to compare the number and frequency of couples with and without balanced translocation with respect to whether liveborn was present or absent. Chi 2 test for trend was used to show whether a correlation existed between the occurrence of balanced translocation and the number of spontaneous abortions at ascertainment.

RESULTS The overall incidence of chromosome anomaly was 51 out of 514 (9.92%). Chi 2 test for trend analysis showed that the chance of one member of a couple being a balanced carrier increased with the number of spontaneous abortions. The chance of finding translocation in couples with liveborn was higher than that in couples without liveborn, but the difference was not statistically significant. We also found that pericentric inversion 9 did not play an important role in the causation of recurrent abortion.

CONCLUSIONS Cytogenetic analysis is indicated in couples with 2 or more spontaneous abortions and the chance of finding chromosomal aberration increases with the number of abortions at the time of ascertainment.

     

Transsphenoidal microsurgical removal of large pituitary adenomas

OBJECTIVE To retrospectively analyze the diagnostic modes, transsphenoidal microsurgical technique and outcomes of 145 patients with pituitary macroadenoma or giant pituitary adenoma.

METHODS A total of 145 patients suffering from pituitary macroadenoma or giant pituitary adenoma with suprasellar extension were performed with transsphenoidal microsurgery in our department. Diagnoses were made by CT or MRI scanning. All adenomas had suprasellar extension (extension size: > 10 mm). Operations were performed via either sublabio-septo-sphenoidal approach or naso-vestibulo-sphenoidal approach under microscope. During operation, a subarachnoid catheter was inserted into the lumbar cistern, via the catheter saline was slowly injected to increase the intracranial pressure (ICP) and to deliver the suprasellar tumor into the operative field for easy removal.

RESULTS The gross total removal of adenoma in 102 patients (70.4%) and subtotal removal in 35 patients (24.1%) were achieved; partial removal was carried out in the remaining 8 patients (5.5%) with fibrous or dumbbell-shaped adenomas. There were no deaths after surgery. Long-term follow-up observation (median: 3.5 years) in 132 patients revealed good recovery in 93 (70.5%) and late recurrence in 39 (29.5%). Those patients with tumor recurrence underwent reoperation, drug therapy, radiotherapy, and radiosurgery either alone or in combination.

CONCLUSIONS Except for fibrous and dumbbell-shaped ones, microsurgical technique via transsphenoidal approach is a safe and effective way to remove large pituitary adenomas.

     

Treatment of cleft lip and cleft palate.

The first case of cheiloplasty recorded was in China at about 200 BC. The technique of course has been vastly improved over the centuries. Cleft lip and/or cleft palate are among the most common congenital anomalies in China and the world. There is controversy over some of the surgical techniques used and age for operation, especially in cleft palate, but the condition requires surgery. Unilateral cleft lip is operated on at 3-6 month of age and bilateral cleft lip at 6-12 month of age. Views on palatoplasty are: 1. Cleft palate should be repaired at an early age; 2. Supplementary orthodontic treatment to expand the upper arch postoperatively is necessary, and orthognathic surgery is performed if needed when the patient has matured. This is the best choice at present.

     

MRI和CT联合诊断33例脑裂畸形的价值及影像特征分析

目的探讨核磁共振成像(MRI)和断层扫描(CT)联合诊断脑裂畸形的价值及影像学特征。方法回顾性分析我院收治的33例脑裂畸形患者的临床资料,均行CT和MRI检查,分析CT、MRI的影像学特征及联合诊断的临床价值。结果33例脑裂畸形患者中,裂隙42个,单侧裂隙24例,双侧裂隙9例;融合型15例,分离型16例,左侧融合型、右侧分离型2例;CT和MRI示大脑半球的横行裂隙,边缘衬有灰质,侧脑室扩大30例,脑室无明显扩大3例;侧脑室呈局限性幕状突起29例;31例伴有脑部发育异常,透明隔缺如18例,灰质异位15例,胼胝体发育异常5例,蛛网膜囊肿3例,多小脑回畸形1例,巨脑回畸形1例。结论CT和MRI均能清晰显示脑裂畸形的影像学特征,对于较为隐匿的脑裂畸形CT容易漏诊,联合MRI诊断的准确性更高。     

脑神经元移行异常的影像学诊断

目的 探讨神经元移行异常的影像学特征，提高对其认识能力和诊断水平。方法 回顾性分析32例临床影像学资料完整的病例，脑裂畸形16例，灰质异位10例，无脑回或巨脑回畸形6例；主要临床表现为智力低下、癫痫和偏瘫等；结果 脑裂畸形特征由灰质相衬的裂隙横跨半球，内达侧脑室，所衬灰质与大脑皮层连续，影像与灰质等密度：灰质异位CT和MRI表现为皮质下白质区，侧脑室室管膜下结节状、团块状或带状病灶，在所有序列上与正常脑灰质信号相同；无脑回＼巨脑回畸形脑表面光滑或部分区域光滑、平坦，脑回、脑沟消失，脑皮层增厚。结论 头颅CT和MRI是显示神经元移行异常最佳检查方法。     

脑裂畸形的CT、MRI诊断

目的 分析脑裂畸形的CT、MRI特点,提高其诊断准确性.材料与方法 回顾分析13例CT、MRI发现的脑裂畸形影的像资料,男8例,女5例,年龄6天-56岁,平均25.3岁.CT 检查10例,MRI 检查4例,CT+MRI 检查3例.结果 本组13例均为单侧单条脑裂畸形,其中分裂型脑裂畸形5条(29.4%),融合型脑裂畸形...     

16层螺旋CT在鳃裂囊肿诊断中的应用

目的探讨16层螺旋CT对鳃裂囊肿的诊断。方法回顾性分析12例经病理证实的鳃裂囊肿CT表现。结果12例中第二鳃裂囊肿11例,第一鳃裂囊肿1例。12例均为单囊,边界清楚。囊内密度均匀,几无强化;囊壁薄呈环状强化。4例颈血管鞘向内后移位,6例胸锁乳突肌向外后移位,4例颌下腺向前移位。结论鳃裂囊肿CT表现典型。增强CT多平面重建可提供更全面的影像信息,利于诊断。     

第三鳃裂囊肿及瘘管2例并文献复习

目的探讨第三鳃裂囊肿及瘘管的临床、影像学表现及术前诊断。方法对2例第三鳃裂囊肿及瘘管的临床、影像学表现、术前及病理诊断进行回顾性分析。结果2例第三鳃裂囊肿及瘘管均位于左侧颈部,反复感染并肿胀．1例为不完全性内瘘管,1例为完全性瘘管,MRI及CT均表现为感染征象,颈部X光片显示为左颈部单个或多个气液平面影,食管稀钡造影表现为钡剂自左侧梨状窝呈细长管状影向前、下方延伸,与颈部气液平面相通。结论颈部MRI或CT对鳃裂囊肿可作出定位诊断,并显示与周围组织间关系,而颈部X光片及食管稀钡造影是诊断第三鳃裂囊肿简便、有效的检查方法,可清晰显示内瘘VI、瘘管走行,三者联合对术前诊断及手术方式的选择有重要意义。     

脑裂畸形的CT、MRI表现(附28例报告)

目的:探讨脑裂畸形的CT、MRI的影像特征。方法:回顾性分析28例脑裂畸形的CT、MRI资料,其中CT检查12例,MRI检查16例。结果:CT、MRI表现为横贯大脑半球的裂隙,裂隙壁由灰质组成。单侧型19例,双侧型9例。共有37个裂隙,融合型(Ⅰ型)15个,分离型(Ⅱ型)22个,合并其他脑先天畸形15例。结论:脑裂畸形有特征性的CT、MRI表现,并可对其分型,是目前诊断脑裂畸形最好的检查方法,且MRI优于CT。     

Rathke囊肿的影像学诊断与鉴别诊断

目的:分析Rathke囊肿的CT和MRI表现,提高对该病的诊断水平。方法:回顾性分析经手术与病理证实的14例Rathke囊肿的CT及MRI资料。结果:14例Rathke囊肿,CT平扫8例,其中4例为低密度,2例等密度,1例高密度,1例囊壁可见钙化。3例CT增强扫描未见明显强化。MRI平扫主要显示为圆形或类圆形,5例位于鞍内,9例位于鞍内及鞍上。6例为长T1、长T2信号,5例为短T1、长T2信号,2例为短T1、短T2信号,1例信号不均匀。12例MRI增强扫描,其中10例未见明显强化,2例囊壁轻度强化。结论:Rathke囊肿囊液密度/信号变化多样,通过总结其影像特点并结合详细的影像学检查可对其中多数病例做出正确的定性诊断。     

利用螺旋CT技术建立单侧完全性唇腭裂上颌骨三维有限元模型

目的:探索快速建立单侧完全性唇腭裂上颌骨三维有限元模型的方法.方法:对单侧完全性唇腭裂患者头颅部进行多层螺旋CT扫描,利用Mimics软件直接将CT扫描样本得到的Dicom标准文件进行处理,并导入逆向工程软件Geomagic Studio来构建模型的表面,在此基础上用Ansys软件建立完整的单侧唇腭裂上颌骨三维有限元模型.结果:建立了由27 405个实体单元和26 876个节点组成的单侧完全性唇腭裂上颌骨有限元模型.结论:应用螺旋CT技术和联合使用Mimics软件、Geomgaic Studio软件对模型进行构建,并结合Ansys软件生成三维有限元计算模型,是一种快速有效地建立单侧完全性唇腭裂有限元模型的方法.     

局限性Castleman病的CT特征分析及病理对照

目的探讨局限性Castleman病的CT表现特点。方法结合临床与病理资料,回顾性分析10例局限性Castleman病,所有患者均行CT平扫和增强扫描,由2名放射学医师同时分析。结果 10例局限型Castleman病中共12个肿块,其中颈部及腋窝各1例均为2个肿块(同一淋巴链区),肺内、纵隔肿块、后腹膜肿块为单发肿块。呈类圆形或椭圆形,直径在3-12 cm间,平均5.6 cm。病理分型为透明血管型7例和浆细胞型3例。透明血管型CT平扫表现为密度均匀,但中间可有条状或裂隙样低密度,而增强扫描表现为除条状或裂隙样低密度外,明显均匀增强,并与腹主动脉同步增强,周围可有点条状增强血管,平扫CT值27-54 HU,增强后CT值在39-145 HU间,且腹部2例相对较大肿块可见钙化及不强化区;浆细胞型CT平扫表现为密度均匀,而增强扫描表现为轻中度均匀增强。结论局限性Castleman病CT表现与发生部位和病理类型密切相关,透明血管型LCD的CT表现具有特征性,而浆细胞型LCD的CT表现则缺乏特征性。     

Rathke囊肿的CT和MRI诊断

回顾性分析经手术与病理证实的19例Rathke囊肿的CT及MRI资料。CT平扫发现4例为低密度,1例为等密度,14例为高密度。MRI平扫发现病变1例位于鞍内,18例位于鞍内并向鞍上延伸。病变呈圆形、椭圆形或哑铃形,T1低信号、T2高信号有6例;T1高信号、T2等信号有5例;T1等信号、T2高信号有4例;T1等信号、T2等信号有3例;T1高信号、T2高信号有1例。19例MRI增强扫描,均未见明显强化。Rathke囊肿囊液密度和信号变化多样,但结合临床和影像学表现对其中多数病例可做出正确诊断。