Leiomyosarcoma in leiomyomatosis of the small intestine.

Multiple leiomyomata of the small intestine are rare. We report one such case where a leiomyosarcoma had arisen from a leiomyoma in the small intestine 8 years after presentation. The possible origin of the leiomyomata is discussed and it is concluded that small intestinal leiomyomatosis should be regarded as a premalignant condition.     

Solitary cutaneous leiomyomata: a clinicopathological study of 28 cases.

Twenty-eight cases of solitary cutaneous leiomyomata were encountered in a ten-year period. They occurred in nine males and nineteen females, the mean age at presentation being 53 years. The lesions occurred most commonly on the lower limbs and 36% were painful. Solitary cutaneous leiomyomata were found to differ from the better known syndrome of multiple cutaneous leiomyomata, in that they did not recur after excision and were not associated with leiomyomata at other body sites.     

Adult polycystic liver disease presenting as portal hypertension

Autosomal dominant polycystic liver disease is a systemic hereditary disorder associated with cyst formation in the ductal organs such as the kidney and liver. Multiple massive cysts are typically found in multiparous women. Portal hypertension as a presenting manifestation is very rare but may be caused by associated hepatic fibrosis or massive hepatic replacement of liver by the cysts. Two cases of adult polycystic liver disease, one in uniparous female and another in a 45-year-old male, both presenting with portal hypertension and without any demonstrable fibrosis in the liver, are reported here.     

Co-secretion of calcitonin gene-related peptide, gastrin-releasing peptide and ACTH by a carcinoid tumour metastasizing to the cerebellum

A carcinoid tumour presenting as Cushing's syndrome is reported. Although no tumour mass could be initially identified the patient returned with first a liver and subsequently a cerebellar mass both of which were resected. Only at post-mortem was the lung primary discovered. ACTH, gastrin-releasing peptide (GRP) and calcitonin gene-related peptide were elevated in plasma before resection of the hepatic tumour. These peptides were demonstrated in both the hepatic and cerebellar tumours by immunocytochemistry and radioimmunoassay. This case illustrates the occasional tendency of primary lung carcinoids to remain small and clinically undetectable while generating secondary tumours which are symptomatic. It is suggested that immunological demonstration of GRP may be diagnostically helpful in directing attention to the lung as a primary site in neuroendocrine tumours which present in this fashion.     

Severe intrahepatic cholestasis in an elderly patient with primary amyloidosis and colon adenocarcinoma

Hepatic involvement in primary amyloidosis (AL type) is not rare but is often clinically silent. However, presentation with jaundice in AL-type amyloidosis is rare, with an incidence of less than 5% reported in the literature. It is considered to be a preterminal sign. We herein report on a case of primary hepatic amyloidosis presenting with severe intrahepatic cholestasis. Viral, drug, alcohol, and autoimmune etiologies were all excluded. A liver biopsy was performed because of unexplained cholestatic jaundice for 3 months. The pathology showed hepatic amyloidosis with extensive amyloid deposition in the expanded portal tracts and sinusoidal space. The patient received supportive treatment only, because of persistent jaundice, coexistent colon cancer with para-aortic lymph node metastasis, and possibly peritoneal carcinomatosis. Unfortunately, the patient died of sepsis 10 months after the onset of jaundice. We suggest that hepatic amyloidosis must be considered in the differential diagnosis of unexplained cholestatic jaundice.     

超声在子宫肌瘤介入术后疗效评价中的应用价值

目的:探讨超声在子宫动脉栓塞术治疗子宫肌瘤术后疗效随访中的应用价值。方法:35例子宫肌瘤患者,分别在栓塞术前1周、术后1个月、3个月、6个月、12个月、24个月运用超声检查子宫,观察子宫形态、肌瘤大小及血流动力学的变化。结果:术后子宫体积平均缩小41.7%,肌瘤体积平均缩小63.3%,其中以单发肌瘤患者疗效明显;肌瘤的血供较术前明显减少,血流流速减低。结论:超声在评价UAE术后疗效中有重要价值。     

小剂量米非司酮治疗子宫肌瘤

目的：了解小剂量米非司酮治疗子宫肌瘤的效果和安全性。方法：有症状的子宫肌瘤患者２８例，口服米非司酮每日１０ｍｇ，连续３个月；治疗期间每月用Ｂ超测量子宫和肌瘤体积，并测血红蛋白、肝肾功能及询问一般情况。结果：治疗后所有病人均闭经，腹痛消失，肌瘤体积缩小４２．６％，贫血均得以纠正，病人一般情况明显好转，无明显副作用。结论：每日１０ｍｇ剂量米非司酮治疗子宫肌瘤是一种安全、有效的方法，适用于手术前和围绝经期子宫肌瘤患者。     

症状性子宫肌瘤动脉栓塞术的疗效观察

目的观察子宫动脉栓塞术治疗症状性子宫肌瘤的疗效及其并发症。方法31例经妇科检查、超声检查确诊伴有症状的子宫肌瘤患者,采用平阳霉素碘油和(或)明胶海绵颗粒行双侧子宫动脉栓塞术。术后随访6月观察肿瘤体积、子宫体积、月经判定疗效。结果90.3%病例临床症状缓解。其中月经量减少(49.1±21.6)%,经期缩短,月经周期无变化;子宫体积平均缩小(42.9±14.8)%;肌瘤体积分别缩小(65.5±23.5)%。结论子宫动脉栓塞术可以有效地缩小肌瘤及子宫体积,明显改善子宫肌瘤的临床症状;除此之外,应该重视和控制并发症的发生。     

Gastrointestinal haemorrhage from leiomyomata of the small bowel

Three cases of haemorrhage from small bowel leiomyomata are reported. The features and management of this rare, but important cause of life-threatening gastrointestinal bleeding, are discussed.     

超声造影对结直肠癌肝转移与原发性肝癌的鉴别诊断

目的:探讨超声造影对结直肠癌肝转移与原发性肝癌的鉴别诊断要点。方法:对结直肠癌肝转移与原发性肝癌患者各30例进行超声造影检查,并对超声检查过程进行定性和定量分析。结果:原发性肝癌组典型增强形态为病灶整体均匀增强,结直肠癌肝转移组的典型增强形态为病灶周边厚环状增强。两组患者的峰值增强强度和50%清除斜率的差异有统计学意义。结论:超声造影检查能对结直肠癌肝转移与原发性肝癌患者进行鉴别诊断,有一定的临床应用价值。     

腹腔镜逆行肝脏Spiegel叶切除术一例报道：一种多样化手术方式选择

The first laparoscopic hepatectomy case was reported by Reich et al in 1991. Initially the laparoscope was utilized diagnostically for resection and biopsy of superficial liver lesions. Recently due to the technological advancement and instrumental improvement, the laparoscopic hepatic resection procedures have evolved significantly.     

雌激素受体基因多态性与子宫肌瘤的相关性研究

目的 探讨雌激素受体-α(ERα)基因多态性与子宫肌瘤发病的相关性.方法 应用聚合酶链反应(PCR)和限制性片断长度多态性分析(WIT)检测86例子宫肌瘤患者(肌瘤组)和80例非子宫肌瘤女性患者(对照组)的ERα基因型,应用免疫组织化学SP法检测子宫肌瘤患者肌瘤组织与正常子宫肌层组织的雌激素受体(ER)、孕激素受体(P...     

原发性肝肉瘤的CT表现

目的：探讨CT对原发性肝肉瘤的诊断价值。方法： 回顾性分析12例经手术病理证实的原发性肝肉瘤的CT表现,包括 平滑肌肉瘤、脂肪肉瘤及恶性纤维组织细胞瘤各2例,血管肉瘤、癌肉瘤、囊腺癌肉瘤、间皮肉瘤、纤维肉瘤、恶性淋巴瘤各1例。结果：121例原发性肝肉瘤中仅2例脂肪肉瘤术前CT诊断正确。对照手术病理所见,肝肉瘤的CT表现可概括为实质性肿块型和囊性肿块型两种类型。实质性肿块型8例,包括脂肪肉瘤2例,平滑肌肉瘤、血管肉瘤、癌肉瘤、间皮肉瘤、纤维肉瘤、恶性淋巴瘤各1例。CT平扫为均匀或不均低密度灶,增强扫描病灶无明显强化,或者呈不均强化、环形边缘强化或边缘结节状强化。边缘强化是血管肉瘤和恶性淋巴瘤共有的特点。以脂肪密度为主、内含多发条索状结构的肿块是脂肪肉瘤的特征性表现。囊性肿块型4例,包括恶性纤维组织细胞瘤2例,平滑肌肉瘤术后复发及囊腺癌肉瘤各1例。均为单发巨大囊性肿块,其中平滑肌肉瘤术后复发者为单房囊性肿块,其他3例为多房囊性肿块,囊壁和（或）分隔厚薄不均,增强扫描囊壁和分隔有明显强化。囊腺癌肉瘤的囊性肿块内可见明显实质成分,并可见壁结节。结论：肝肉瘤的 CT表现与病理类型有关,部分病理类型如脂肪肉瘤、血管肉瘤有一定特征性CT表现,大部分肝肉瘤缺乏特征性影像学表现,应结合临床表现和实验室检查结果综合判断,确诊依靠病理检查。     

不同肝背景下原发性肝癌超声造影灌注特征的定量分析

目的: 探讨正常肝、肝硬化及脂肪肝背景下原发性肝癌的超声造影表现,定量分析3种肝背景下原发性肝癌的血流灌注特征。 方法: 选择137例原发性肝癌患者共137个原发病灶,依据肝背景不同分为正常肝背景组(45例)、肝硬化背景组(51例)和脂肪肝背景组(41例)。观察3种肝背景下病灶的超声造影特征;应用时间-强度曲线分析3种肝背景组原发性肝癌的灌注参数,包括始增时间、达峰时间、峰值强度、梯度和灌注期曲线下面积。 结果: 本组137个病灶均表现为动脉相快速高增强,绝大多数病灶表现为典型的"快进快退"增强模式;但在正常肝背景组有6.7%、肝硬化背景组有31.4%的病灶表现为门脉相和延迟相呈等增强,甚至部分病灶内出现局部高增强的表现,即呈"快进慢退"增强模式;时间-强度曲线分析,3组肝背景下任2组病灶的始增时间、达峰时间、峰值强度、梯度及灌注期曲线下面积比较差异均无统计学意义 (P>0.05)。 结论: 3种肝背景下原发性肝癌的超声造影表现存在差异,但灌注参数无明显差异,应用时间-强度曲线能够客观准确地分析原发性肝癌超声造影的灌注参数,对病灶做出正确诊断。     

中医药治疗原发性肝癌的用药特点分析

目的：探讨中药治疗肝癌的用药特点,为临床用药提供参考依据。方法：搜集2003～2010年国内公开发表的中医药治疗原发性肝癌的相关文献51篇,应用频数法对其用药特点进行统计分析。结果：原发性肝癌治疗用药中,补虚药、清热药、活血化瘀药、利水渗湿药应用频率较高,累计频率71.81%,其中以茯苓、白术、白花蛇舌草、半枝莲、黄芪、柴胡应用最多。结论：治疗原发性肝癌中医用药有一定的规律和特点,对临床有指导意义。     

Carcinoma of the sigmoid colon presenting as a scrotal swelling.

A case of adenocarcinoma of the sigmoid colon, presenting as a testicular mass, is described. At sigmoid colectomy widespread metastases were found and only palliative care could be offered thereafter. The incidence and age of such a presentation and manner of spread of the occult primary are discussed.     

Tumour seeding following percutaneous needle biopsy of hepatocellular carcinoma

We report a hepatocellular carcinoma seeding following needle biopsy in a 57-year-old man who first presented with a focal hepatic lesion at another hospital. The patient had been a hepatitis B carrier for 20 years. Initial surveillance ultrasonography showed a lesion in segment IV, in the background of non-cirrhotic liver and normal serum alpha-foetoprotein level (8 ng/ml). A percutaneous needle biopsy was done and histopathology confirmed well-differentiated hepatocellular carcinoma. The patient had refused surgery and preferred to try traditional medicine. He presented to us four months after the initial biopsy with epigastric swelling. This was found to be due to a tumour seeding along the previous biopsy tract. He was given radiofrequency ablation (RFA) of tumour along the needle tract, in addition to the primary tumour. We conclude that the need for percutaneous needle biopsy should be critically evaluated in patients presenting with focal hepatic lesions and the role of RFA in treating tumour seeding needs further evaluation.     

Hepatic tuberculosis: a rare cause of fluorodeoxyglucose hepatic superscan with background suppression on positron emission tomography

Fluorodeoxyglucose (FDG) hepatic superscan refers to the diffuse intense uptake of 18F-FDG in the liver on positron emission tomography (PET), with reduced physiological activity in the brain and heart. The common causes include lymphoma and metastasis. In this case report, we describe the imaging features of tuberculosis as a rare cause of FDG hepatic superscan. PET imaging may be the only clue to a diagnosis of hepatic tuberculosis, as other imaging modalities may demonstrate only nonspecific hepatomegaly. It is important to consider this entity in the differential diagnosis of patients presenting with FDG hepatic superscan and proceed with liver biopsy for a definitive diagnosis.     

肝切除术治疗原发性肝癌96例临床分析

目的：总结肝切除术治疗原发性肝癌疗效。方法：1996年1月－2001年9月对96例原发性肝癌行肝切除术。回顾性分析肿瘤分布，手术方式及手术疗效。效果：肝癌切除96例，其中左肝癌切除25例，右肝癌切除71例，术后出现并发症30例，围手术期死亡4例。1、3年生存率分别为87．5％和43．8％。结论：肝切除术仍是治疗原发性肝癌的最有效方法。     

初级纤毛的若干研究进展

初级纤毛是近年来生物医学领域的一个研究热点.它是一种广泛存在于各种细胞表面的细胞器,体形微小但结构复杂,作用强大,具有重要的感官作用,能感知细胞外机械和化学信号变化并协助其转导至细胞内部,从而引起细胞应答.近年发现Hedgehog、Wnt等多种发育信号通路的运行和调控依赖于初级纤毛,决定了它在人体许多组织和器官的发育成形及正常生理活动中扮演重要角色,同时也决定了其结构和功能的异常导致多种纤毛相关疾病的发生,包括一些遗传病和肿瘤等.随着免疫荧光染色、共聚焦显微镜观察等新实验方法的应用,人们对初级纤毛有了更深入的了解,为进一步指导纤毛相关疾病的干预诊疗奠定了基础.