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51.
《Annals of medicine》2013,45(6):441-446
Acute aortic dissection (AAD) is a life-threatening disease with an incidence of about 2.6–3.6 cases per 100,000/year. Depending on the site of rupture, AAD is classified as Stanford-A when the ascending aortic thoracic tract and/or the arch are involved, and Stanford-B when the descending thoracic aorta and/or aortic abdominal tract are targeted. It was recently shown that inflammatory pathways underlie aortic rupture in both type A and type B Stanford AAD. An immune infiltrate has been found within the middle and outer tunics of dissected aortic specimens. It has also been observed that the recall and activation of macrophages inside the middle tunic are key events in the early phases of AAD. Macrophages are able to release metalloproteinases (MMPs) and pro-inflammatory cytokines which, in turn, give rise to matrix degradation and neoangiogenesis. An imbalance between the production of MMPs and MMP tissue inhibitors is pivotal in the extracellular matrix degradation underlying aortic wall remodelling in dissections occurring both in inherited conditions and in atherosclerosis. Among MMPs, MMP-12 is considered a specific marker of aortic wall disease, whatever the genetic predisposition may be. The aim of this review is, therefore, to take a close look at the immune-inflammatory mechanisms underlying Stanford-A AAD.  相似文献   
52.
目的:研究腔镜辅助下行分化型甲状腺癌颈淋巴结清扫术的可行性,探索手术治疗分化型甲状腺癌的新方法。方法:为7名分化型甲状腺癌患者行腔镜辅助下功能性颈淋巴结清扫术,其中4例为甲状腺癌联合根治术。就手术的清扫范围、手术时长、术中失血量、术后病理结果、并发症、患者满意度等多方面进行分析。结果:全部病例手术顺利,清扫范围可以达到传统开放式手术范围。整体手术时长平均214分钟,平均失血量约137ml。病理显示颈部各区清扫组织均可见数目不等的淋巴结,并有部分癌转移。伤口愈合良好,无并发症,患者满意度100%。结论:在腔镜辅助下行颈淋巴结清扫术是安全可行的,较完全腔镜式和传统开放式手术,在美容、微创、疗效三方面互有补裨,相得益彰。该技术可用于分化型甲状腺癌的手术治疗。  相似文献   
53.
目的研究内镜黏膜下剥离术(ESD)治疗消化道早癌或癌前病变的长期疗效以及术后复发的影响因素。方法收集73例患者的临床及随访资料。采用Kaplan-Meier法,Log-rank和Breslow检验,以及Cox风险比例模型进行统计学分析。结果胃和结直肠ESD术后中位无复发生存时间(DFS)大于该研究最长随访时间(65个月),食管中位生存时间为44.5个月;与胃和结直肠相比,食管ESD术后DFS明显减少(χ~2=12.61,P=0.000;χ~2=7.09,P=0.008);病灶异型程度(浸润深度)和病灶面积影响ESD术后DFS(P=0.027,OR=2.38,95%CI:1.10~5.12;P=0.074,OR=0.90,95%CI:0.80~1.01)。结论 ESD术是切除消化道早期癌和癌前病变并维持长期不复发的有效内镜下手术方法 ;异型程度(浸润深度)是影响ESD术后DFS的独立危险因素;病灶面积在影响ESD术后的DFS方面具有临床意义。  相似文献   
54.
This review article describes and illustrates the role of angiography and magnetic resonance imaging in the evaluation of aortic dissection. Clinical findings, complications, classification, and treatment of dissection are reviewed as well.  相似文献   
55.
A 50-year-old woman presented a sudden left occipital headache and a posterior circulation stroke after cervical manipulation for neck pain. Magnetic resonance imaging documented a left intracranial vertebral artery occlusive dissection associated with an ipsilateral internal carotid artery dissection with vessel stenosis in its prepetrous tract. This is the first reported case showing an associate vertebral and carotid artery dissection following cervical manipulation. Carotid dissection was asymptomatic and, therefore, its incidence may be underestimated. We emphasize that cervical manipulation should be performed only in patients without predisposing factors for artery dissection and after an appropriate diagnosis of neck pain. Received: 25 October 1997 / Accepted: 19 August 1998  相似文献   
56.
Differentiated thyroid cancer grows slowly in general. But some patients repeat recurrence and progress finally to death. To clarify the difference of their prognosis and establish the appropriate thyroid surgery, we studied 105 patients with differentiated thyroid cancer who were treated with total or subtotal thyroidectomy, excluding those with small tumors, under uniform conditions regarding thyroidectomy. There were 77 women and 28 men aged 19 to 76 years (mean 54.7 years). More than 60% (alive) were followed up for longer than 10 years. Thirty-eight (36%) patients had recurrences. There were 19 deaths. Twelve of 31 patients with locoregional recurrence died and 7 of these 12 died of locoregional control failure (neck and mediastinum). Age at first operation, tumor size, and local tumor extension increased the rate of recurrence significantly. Multivariate analysis confirmed that age, locoregional recurrence, and distant metastasis significantly affected survival. Although lymph node metastases were not a prognostic factor, for patients at high risk for recurrence who are older, and have large tumors with invasion, complete resection of cervical lymph nodes is advised to prevent local recurrence and prolong the disease-free interval. Prolongation of the disease-free interval may lead to prolonged survival time.  相似文献   
57.
Katoh T  Gohra H  Hamano K  Noda H  Fujimura Y  Zempo N  Esato K 《Surgery today》1999,29(12):1290-1293
The results of surgical treatment for a ruptured type B aortic dissection remain far from satisfactory. It is believed that additional perfusion from the right axillary artery might be more beneficial than perfusion from only the femoral artery during surgery for a ruptured thoracic aneurysm. The right axillary perfusion is more likely to perfuse the vital organs proximal to the ruptured area, and thus avoid retrograde emboli. In addition, if the open proximal method is performed, then the right axillary perfusion is able to facilitate the evacuation of air from the aortic lumen. We present herein the case of a patient in whom a ruptured type B acute aortic dissection was successfully treated by applying right axillary perfusion through a left thoracotomy.  相似文献   
58.
现代面部除皱术的面神经解剖学研究   总被引:1,自引:0,他引:1  
目的明确 SMAS 与面神经的关系。方法对12具(24侧)成人尸头行大体解剖观察。结果 SMAS 分布于面中部,向前逐渐变薄,于口角水平外侧有小范围的“洞区”。面神经出腮腺后,并非在 SMAS 深面,而是在咬肌筋膜深面走行。面神经额支在颧弓以下0.5cm 区域穿出深筋膜,跨过颧弓。在颊脂肪垫区,大部分面神经分支走行在垫内,小部分分支形成面神经丛,分布于其表面。在颧大肌表面上1/3恒定有一颧支跨过,支配眼轮匝肌下外侧9例(占37.5%);颧大、小肌及眼轮匝肌8例(占33.3%);颧大、小肌7例(占29.2%)。结论面部多层次剥离除皱术应在颧弓以下0.5cm 区域行 SMAS 下剥离,至面中部时,应注意保护颧大肌表面上1/3段的面神经颧支,只在颧大肌中下2/3段区域进行剥离,向内掀起颧脂肪垫;或通过下睑缘皮肤切口,向下掀起眼轮匝肌(注意保护位于颧大肌上1/3段的面神经颧支),与经耳前 SMAS 下剥离腔隙连通,如上操作可避免面神经损伤。  相似文献   
59.
A 63-year-old man was referred to our institute for the treatment of squamous cell carcinoma of the upper lobe of his right lung. A right upper lobectomy of the lung was performed with a mediastinal lymph node dissection. The postoperative pathological examination of the dissected specimens revealed one of the superior mediastinal lymph nodes to be morbid with micrometastasis of occult thyroid cancer, while no node involvement was seen due to lung cancer. A right lobectomy of the thyroid gland with a modified radical neck dissection was done 4 years later after the confirmation of the absence of any recurrent sign of lung cancer. In the resected specimen, papillary thyroid microcarcinoma was observed with several intraglandular metastases and right regional lymph node involvement. Eight months later, a new primary lung cancer developed in the left lung, and a left upper lobectomy of the lung with a mediastinal lymph node dissection was performed. At that time, the absence of mediastinal lymph node metastasis from lung cancer or thyroid cancer was confirmed. Mediastinal lymph node involvement as the initial manifestation of occult thyroid cancer in surgical treatment for lung cancer is rare, but it is important to be aware of the possibility of incidentally detecting occult thyroid cancer in surgical dissections in this area for lung cancer. The appropriate surgical treatment should be determined while carefully considering the prognosis of the lung cancer as well as that of any coexisting malignancy.  相似文献   
60.
We present a case of a ruptured abdominal aortic aneurysm (AAA) with ambiguous accessory findings on post-mortem computed-tomography (PMCT), post-mortem magnetic resonance (PMMR) imaging, and PMCT-angiography (PMCTA) suggestive of thoracic aortic dissection. The diagnosis of ruptured AAA was confirmed by autopsy; however, there was no aortic dissection. The imaging findings that mimicked the presence of aortic dissection might have been an atypical presentation of post-mortem clotting or sedimentation. This case is an ideal example to illustrate benefits, limitations, and challenges of post-mortem cross-sectional imaging. It serves as a reminder that both, training as well as correlation of imaging findings with autopsy are fundamental to improve our understanding of radiologic findings on post-mortem cross-sectional imaging.  相似文献   
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