同期放化疗联合深部热疗治疗食管癌术后纵膈淋巴结转移的临床观察

目的探讨同期放化疗联合深部热疗治疗食管癌术后纵膈淋巴结转移患者的近期疗效及毒副反应。方法观察并分析川北医学院附属医院肿瘤科2011年6月-2013年1月收治的64例食管癌术后纵膈淋巴结转移患者,所有均接受同期放化疗联合深部热疗。结果深部热疗配合同期放化疗治疗食管癌术后纵膈淋巴结转移的总有效率为90．63％,其中完全缓解（CR）为42．19％,部分缓解（PR）为48．44％,且疗效与纵膈淋巴结的大小有关（P〈0．05）;其毒副反应以1～2级放射性食管炎、白细胞减少和放射性皮炎为主。结论同期放化疗联合深部热疗的治疗模式对于食管癌术后纵膈淋巴结转移的患者来说高效且较安全,其远期疗效值得进一步关注。     

Nail involvement in osteoarthritis

Summary Two cases of nail involvement associated with primary interphalangeal osteoarthritis of the hand, including leukonychia and longitudinal nail ridge, are reported. Osteoarthritic changes of the distal interphalangeal joints may cause nail lesions by exerting direct pressure on the nail matrix or by interfering with local blood flow. Moreover, inflammation of the Heberden's nodes is often present and seems to participate in the development of nail alteration. In our patients, leukonychia disappeared after local steroidal anti-inflammatory treatment of the osteoarthritic node and longitudinal nail ridge disappeared after treatment with nonsteroidal anti-inflammatory agents.     

阴茎切除术和同期改良腹股沟淋巴结清扫术治疗阴茎癌10例的近期疗效

目的 总结阴茎切除术和改良腹股沟淋巴结清扫术同期治疗阴茎癌的近期临床效果.方法 术前5-7天使用抗菌药,阴茎局部及腹股沟区高锰酸钾溶液泡洗,先行阴茎部分切除术或阴茎全切+会阴尿道造口术,同期行改良腹股沟淋巴结清扫术.清扫时皮肤切缘缝线作为牵引,沿浅筋膜浅层和浅筋膜深层之间少血管平面分离,术后皮瓣下置多孔引流管接负压吸引,皮瓣用丝线固定于相应位置的深筋膜处,皮缘处分浅筋膜浅层,皮肤两层缝合.结果 中位术后住院日14天(范围10～18天),出院时伤口痊愈或仅有小的并发症.伤口部分裂开1侧.皮肤切口边缘坏死6侧(30%),无腹股沟皮瓣感染或深静脉血栓.无下肢淋巴水肿、淋巴囊肿或血肿.随访1-28个月.平均18个月.无瘤生存10例,无阴茎或腹股沟处复发.结论 阴茎切除术和改良腹股沟淋巴结清扫术同期治疗阴茎癌,并发症发生率无增高.采用改良的腹股沟清扫术可以降低并发症的发生率.由于病例数少,随访时间短,对预防腹股沟淋巴结复发和提高患者长期生存率有待进一步的临床研究.     

Ultrastructural evidence of a peripheral nervous system pattern of myelination in the avascular retina of the guinea pig

Summary Myelination of axons in the nerve fiber layer (NFL) of the retina occurs as a sporadic abnormality in several mammalian species including man, monkey, cat and rat. All of these species have vascularized retinae and, in the latter three, ultrastructural studies have demonstrated the pattern of medullation to be similar to Schwann cell myelination in the peripheral nervous system. This contrasts with an oligodendrocytic pattern of myelination normally present in the avascular retina of the rabbit. One possible explanation for this difference is that the pattern of myelination is related to the presence or absence of retinal blood vessels. The present investigation provides the first evidence of NFL myelination in another avascular retina, that of the guinea pig. Myelination in the guinea pig retina was observed in a single bundle of axons and involved only large diameter fibers. With several axons, myelin sheaths terminated at hemi-nodes of Ranvier and in all such cases this occurred in association with marked paranodal infolding. Morphological characteristics of the myelination include (1) a one to one relationship between axon and myelinating cell, (2) cytoplasm between myelin sheath and plasma membrane, (3) basal lamina surrounding the myelinating cell, (4) collagen fibers in the adjacent extracellular space and (5) double intraperiod lines. These morphological features are characteristic of peripheral nerve myelination by Schwann cells. Thus, in all species so far described in which retinal medullation is abnormally present, the pattern of myelination has been Schwann cell in nature rather than oligodendrocytic. The reasons for this Schwann cell predominance remain undefined.Supported by the Medical Research Council of Canada     

Paranodal structure in diabetic sensory polyneuropathy

Observations have been made on the structure of the paranodal region at nodes of Ranvier in the sural nerve of patients with diabetic sensory polyneuropathy. The structure of the paranodes was examined with particular attention to the definition and assessment of axoglial dysjunction, which has been claimed to be a characteristic feature of both human and experimental diabetic neuropathy and which has been related to paranodal swelling. In the present series of cases it was not possible to confirm that axoglial dysjunction is a distinctive feature of diabetic polyneuropathy in fibres not undergoing active demyelination or wallerian-type degeneration, neither was excessive paranodal enlargement found. Received: 11 March 1996 / Revised, accepted: 10 June 1996     

Lymphotrophic nanoparticle enhanced MR imaging (LNMRI) for lymph node imaging

Nodal staging is an integral part of the pretreatment staging of any patient with malignancy and has therapeutic and prognostic implications. Currently used imaging techniques used for nodal evaluation are limited in accuracy because they rely on size criteria for the detection of metastases. This has led to the emergence of lymphotropic nanoparticle enhanced magnetic resonance imaging as a promising tool for nodal characterization. This article reviews the properties of lymphotropic iron oxide nanoparticles and the technique, image interpretation, and initial clinical experience with lymphotropic nanoparticle enhanced magnetic resonance imaging.     

AJCC与JSCCR对直肠癌盆腔侧方淋巴结定义演变的解读

侧方淋巴结清扫仍是直肠癌手术治疗的重要术式,但对于直肠癌的盆腔侧方淋巴结是否为区域淋巴结及侧方淋巴结清扫术的意义,欧美与日本专家有不同的观点。对盆腔侧方淋巴结的不同定义会导致直肠癌的分期不同,进而导致不同的治疗决策。不同时期的欧美学者及日本学者对盆腔侧方淋巴结的定义有一个演变过程,笔者根据现有资料对该演变做一解读。由于日本学者对侧方淋巴结研究较多,故重点阐述日本大肠癌研究会对侧方淋巴结的定义演变。     

腹腔镜联合髂腹股沟淋巴结清扫术在黑色素瘤淋巴结转移中的应用

目的探讨腹腔镜联合髂腹股沟淋巴结清扫术在黑色素瘤淋巴结转移中的应用效果。 方法回顾性分析第四军医大学西京医院2015年5月至2017年2月收治的9例转移性黑色素瘤患者,均为下肢原发灶切除术后、IFN-β治疗期间经影像学检查发现髂血管旁和(或)腹股沟区淋巴结转移。手术方式为腹腔镜自髂血管分叉逆行清扫髂血管旁淋巴结,开放手术清扫腹股沟区淋巴结。 结果9例手术均顺利完成。平均手术时间(150.9±41.08)min、平均术中出血量(55±21.51)ml、平均术后下床活动时间(3.11±1.67)d、平均术后住院时间(8.57±2.19)d,术后病理均证实为髂血管旁淋巴结和(或)腹股沟区淋巴结转移。 结论腹腔镜联合髂腹股沟淋巴结清扫术是治疗下肢黑色素瘤转移的新术式探索,该术式手术创伤较小、恢复较快、清扫彻底,具备一定的临床应用价值。     

中央区浅层淋巴结与甲状腺乳头状癌右喉返神经后方淋巴结的相关研究

目的　自右颈中央区浅层（右颈VI-1区）淋巴结转移情况探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）患者何时需行右喉返神经后方淋巴结（1ymph node behind the right recurrent laryngeal nerve,LN-prRLN）清扫术。方法　自2014年3月～2015年9月杭州市第一人民医院集团306例右侧或双侧PTC患者,分析右颈VI-1区淋巴结转移情况、转移个数、转移灶大小对LNprRLN转移的预测价值。结果　右颈VI-1区淋巴结转移个数以及转移灶大小对于预测LN-prRLN转移有统计学差异,当右颈VI-1区淋巴结转移个数为1.5个,其敏感度及特异度分别为78.43%及76.65%,其曲线下面积（area under curve,AUC）值为0.813;当右颈VI-1区淋巴结转移灶大小为0.45 cm时,其敏感度为90.20%,特异度为48.90%,其AUC值为0.726,具有诊断价值。结论　双侧或右侧PTC患者,当右颈VI-1区淋巴结转移个数≥2个且转移灶＞0.45 cm时,需行LN-prRLN清扫。     

头颈肿瘤颈淋巴结包膜外侵犯研究现状

淋巴结包膜外侵犯（extracapsular spread,ECS）广泛存在于头颈部恶性肿瘤,在其浸润与转移中起到重要作用,被认为是重要的预后指标之一。本文回顾了近年来ECS的研究进展,涉及其发生发展机制、临床病理诊断、预后状况与指导性治疗方式等。对于ECS病理学检查仍为其金标准,而各类影像学检查方式也各有优劣而被综合使用;治疗方式建议采用选择性颈淋巴清扫术,伴辅助放化疗。