进展期胃癌淋巴结转移的特点及临床意义

目的 探讨胃癌淋巴结(LN)转移的规律,指导胃癌LN廓清手术治疗。方法 回顾分析我院近5年来D_2或>D_2手术并有完整记录的298例进展期胃癌患者的临床资料,统计胃癌各组LN的转移情况。结果 术中LN肉眼检查与实际病理检查有一定的误差。D_2手术时,只要把No.12LN包括在内,部分LN归属哪一组,并不影响肿瘤的治疗和预后。在各组LN中,No.3、No.7、No.8、No.9 LN转移率最高,而No.13、No.17、No.18 LN对于不同部位的胃癌转移机会均很少,不同部位的胃癌No.3、No.4、No.7、No.8、No.9、No.11、No.16 LN转移机会大致相同。胃癌的LN跳跃式转移见于No.16 LN,而第3站的LN较为少见。探查时若无No.12 LN转移,No.13 LN病理检查均未见转移,可不必清扫。组织学类型分化低的胃癌其第3、4站LN转移相对少见,这可能与分化低的肿瘤易引起远处转移,而使患者失去根治手术的机会有关。结论 掌握胃癌LN的转移规律,对胃癌LN的廓清手术具有重要意义。     

Environmental radioactivity at Stromboli (Aeolian Islands).

HPGe gamma spectrometry, thermoluminescence dosimetry, X-ray diffractometry and fluorescence techniques have been used to analyze the natural radionuclides content of soil and rock samples, air kerma and geochemical features on the island of Stromboli, belonging to the Aeolian Islands, in the Mediterranean Sea. The 214Bi, 238Ac, and 40K contents obtained are in agreement with the magmatic evolution of the rock formation, as shown by the correlations between radionuclide and chemical elements abundacies, depending on the various magmatic differentiation mechanisms. Correlations between radiometric, lithological and geochemical data have been assessed in order to obtain some hints on the geochronology of the magmatic products.     

Focal lesions in cirrhotic liver: what else beyond hepatocellular carcinoma?

Detection and characterization of focal lesions in the cirrhotic liver may pose a diagnostic dilemma. Several benign and malignant lesions may be found in a cirrhotic liver along with hepatocellular carcinoma (HCC), and may exhibit typical or atypical imaging features. In this pictorial essay, we illustrate computed tomography and magnetic resonance imaging findings of lesions such as simple bile duct cysts, hemangioma, focal nodular hyperplasia-like nodules, peribiliary cysts, intrahepatic cholangiocarcinoma, lymphoma, and metastases, all of which occur in cirrhotic livers with varying prevalences. Pseudolesions, such as perfusion anomalies, focal confluent fibrosis, and segmental hyperplasia, will also be discussed. Imaging characterization of non-HCC lesions in cirrhosis is important in formulating an accurate diagnosis and triaging the patient towards the most appropriate management.The detection and characterization of focal lesions in a cirrhotic liver on computed tomography (CT) and magnetic resonance imaging (MRI) is a challenging task due to the marked changes in the organ architecture. Although hepatocellular carcinoma (HCC) is the most frequent primary tumor arising in a cirrhotic liver, several other benign and malignant lesions may be encountered in this setting (1, 2). It is thus not surprising that CT and MRI have limited specificity for the diagnosis of HCC in cirrhosis.Imaging characterization of focal lesions in cirrhosis is of the utmost importance for appropriate patient management. The radiologist’s primary task is to maximize tumor detection (i.e., minimize false negatives), because missing the diagnosis of HCC may preclude potentially curative therapies, such as hepatic resection, percutaneous ablation procedures, and, in selected patients, liver transplantation. However, it is equally important to avoid the misdiagnosis of benign liver lesions as HCC (i.e., minimize false positives) because this diagnostic interpretation may incorrectly increase the tumor burden. This may also result in the ineligibility of the patient for potentially curative treatments or the inappropriate assignment of increased priority scores for patients on the waiting list for liver transplantation. In this paper, we discuss and illustrate CT and MRI features of both common and uncommon non-HCC liver lesions occurring in cirrhotic patients.     

Keratoprosthesis results in animals: An update

Background: The report presented is an update on continuing development work on modified PHEMA core-and-shirt KPros in animals. Methods: Two variations (improved wet-eye, and dry-eye) of a prototype core-and-skirt Chirila KPro are described. The clinical success rate on implantation of these versions of the Chirila KPro was assessed. Results: It was found that a significant improvement in retention rate was shown in the improved model but that the dry-eye model failed early in two of the three implanted. Conclusions: The significance of the improved strength and the reasons for disappointing results with the early dry-eye KPros are discussed. Ongoing work is briefly outlined.     

Digital cineradiographic study of swallowing in patients with amyotrophic lateral sclerosis

PURPOSE: This study was performed to evaluate the usefulness of digital cineradiography in detecting swallowing disorders in dysphagic patients affected by amyotrophic lateral sclerosis (ALS) with a view to planning an adequate therapeutic approach. MATERIAL AND METHODS: From January 2005 to September 2006, 23 patients (10 men and 13 women; mean age 41.3+/-8.6 years) affected by ALS were evaluated with digital cineradiography to assess the grade of dysphagia. All patients were classified using the Hillel ALS Severity Scale (ALSSS). All examinations were performed with radiocontrolled equipment provided with a digital C-arm. RESULTS: The cineradiographic technique enabled us to differentiate patients with disorders of the oral (17/23) and/or pharyngeal (19/23) swallowing phase from those without swallowing dysfunction (4/23). In 14/23 patients, passage of contrast medium into the upper airways was observed during swallowing, whereas in 5/23 cases, aspiration of contrast medium into the lower airways was recorded. CONCLUSIONS: The videofluoroscopic swallowing study has high diagnostic capabilities in the evaluation of swallowing disorders, as it is able to identify the degree and causes of impairment. In addition, the study proved useful for planning speech therapy and for follow-up in patients with ALS.     

Retromuscular sutured incisional hernia repair: a randomized controlled trial to compare open and laparoscopic approach

To compare the early and intermediate results of the open and laparoscopic tension-free repair of incisional hernia, 24 patients were randomized prospectively to undergo laparoscopic or open repair of incisional hernia with retromuscular placement of the prosthesis using transabdominal sutures for mesh fixation. All the procedures were completed as planned. The mean duration of surgery was not significantly different between the 2 groups (P=0.15). Time to oral solid food intake was longer in the open group (P=0.002). The analgesic requirement was lower in the laparoscopic group (P=0.05). One patient after open surgery and 2 in the laparoscopic group suffered postoperative complications (P=0.71). Postoperative stay was shorter in the laparoscopic group (P=0.006). No readmission or recurrence was registered within 6 months from surgery in either group. Laparoscopic incisional hernia repair, based on the Rives-Stoppa technique, is a safe, feasible alternative to open techniques. However, larger studies and long-term follow-up are required to further evaluate the true effectiveness of this operation.     

Characterization of hypoechoic focal hepatic lesions in patients with fatty liver: diagnostic performance and confidence of contrast-enhanced ultrasound

The objective of this study was to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) to characterize hypoechoic focal hepatic lesions (HFHL) in fatty liver (FL). A study group of 105 patients with FL and 105 HFHLs (52 malignant and 53 benign) underwent CEUS after SonoVue administration. Two blinded readers independently reviewed baseline ultrasound (US) and CEUS scans and classified each lesion as malignant or benign on a five-point scale of confidence, and recorded whether further imaging work-up was needed. Sensitivity, specificity, areas under the receiver operating characteristic (ROC) curve (A (z)), and interobserver agreement were calculated. We observed that the diagnostic confidence improved after reviewing CEUS scans for both readers (A (z)=0.706 and 0.999 and A (z)=0.665 and 0.990 at baseline US and CEUS, respectively; p<0.0001). Inter-reader agreement increased (weighted k=0.748 at baseline US vs. 0.882 at CEUS). For both readers, after CEUS, the occurrence of correctly characterized lesions increased (from 27/105 [27.5%] to 94/105 [89.5%], and from 19/105 [18.1%] to 93/105 [88.6%], respectively; p<0.0001) and the need for further imaging decreased (from 93/105 [88.6%] to 26/105 [24.8%], and from 96/105 [91.4%] to 40/105 [38.1%], respectively; p<0.0001). We conclude that CEUS improves the diagnostic performance of radiologists in the characterization of HFHLs in FL and reduces the need for further imaging work-up.     

Attempts to isolate BK virus from children affected by various diseases

Attempts to isolate BK virus (BKV) from specimens (urine, faeces, throat and nasal swabs and cerebrospinal fluid) obtained from 150 children affected by various diseases failed. Sera from the same children contained in 60.7% of cases high titres of antibodies to BKV.