先天性回肠、盲肠不连接及结肠发育不良

20 0 3年 5月 9日 ,男婴 ,体重 3 2 0 0 g ,足月平产 ,坐高 5 0cm ,能吸吮 ,已哺乳 ;外观头、颈、躯干、四肢无异常。出生 3 6h后出现腹胀、呕吐 ,呕吐物为黄绿色 ,无排便、排气、发吭、呼吸急促 ,收住入院。入院后 ,当时护士给予肛门插管排气处理一次 ,无排气 ,肛管无排便。立即抱入X光室胸透 ,发现右肺有大片阴影 ,膈下有游离气体 ,婴儿无呼吸、心跳、随即死亡。经解剖发现 ,心、肺、肝无异常 ,打开腹腔后 ,有大量的胎粪溢出 ,经纱布擦洗处理。首先肉眼看到回肠末端有 0 .3cm×0 .3cm的裂孔 ,此处有胎粪流入腹腔。经胃沿小肠依次寻找考察…     

原发性小肠透明细胞腺癌1例

患者女性,83岁,因腹胀伴呕吐3个月余入院。患者3个月前出现上腹部胀痛,伴有呕吐、口苦,无发热、血便及血尿。体检:腹稍膨隆,未触及肿块,腹部轻压痛,无反跳痛,叩诊呈鼓音,肝肾区无叩痛。肿瘤标志物CEA 12.5 ng/mL。PET/CT检查示左上腹小肠肠壁增厚,糖代谢增高,考虑恶性肿瘤伴不全性肠梗阻;盆腹腔多发结节,糖代谢增高,考虑转移瘤。临床诊断:(1)小肠占位伴不全性肠梗阻,小肠恶性肿瘤可能;(2)盆腹腔多发占位,转移瘤可能。遂行“腹腔镜探查+小肠肿瘤切除+盆腔结节活检+浆膜腔热灌注化疗术”,术中见上段小肠肿瘤,大小4 cm×4 cm×3 cm,肠系膜及盆腔(子宫及双侧附件、膀胱表面、结直肠系膜及腹膜)可见多发转移性结节病灶。术后患者接受化疗,随访3个月,生命体征平稳,未见肿瘤复发。     

胆囊癌肉瘤1例

患者 ,女性 ,4 7岁。“B超发现胆囊占位性病变 1周”入院。患者无胆囊结石或胆囊炎病史。入院后CT示胆囊壁增厚 ,胆囊内可见多个软组织阴影 ,胆囊床无改变 ;肝左叶外段、内段多个类圆形低密度区 ,最大直径约 2 4cm ,最小直径 1 0cm ;门腔静脉间隙有肿大淋巴结 ,直径约 3 5cm。术中见 :胆囊内有 2cm× 2cm× 5cm的肿块 ,相邻的胆囊床及左肝内叶变硬并有包块感 ,肝总管淋巴结肿大。切除左肝内叶、胆囊及肿大的胆总管淋巴结送病理检查。病理检查　眼观 :胆囊体积约 6 0cm× 3 5cm× 3 0cm ,囊内可见息肉样肿物 ,约 2 0cm× 2 5cm× 1 0cm…     

炎症性肌纤维母细胞瘤恶性变一例

患者女,14岁。因腹部轻度膨隆和低热于2004年7月入院。CT和B超发现腹部有一个直径5cm左右的肿块,实验窜检奁示轻度贫血外,余无异常。术中见1个边界较清楚但无包膜的肿块,约5．0cm×4．0cm×3．5cm,完整切除肿块。但在腹腔、大网膜、肠管浆膜层分布几十枚直径0．5～1．5cm的厌白色结节,无法切除。腹腔内有少帚渗液。术后腹水逐渐增多,呼吸困难,需定期吸除腹水。除此外患并一般状况尚可。石蜡切片经我院会诊．诊断炎症性肌纤维母细胞瘤（IMT）。因经放疗、化疗无效,遂予以干扰素、白蛋白等治疗．但腹水无减少,仍需定期吸除。术后1个月转入我院治疗。再次打开腹腔,放净腹水,见腹腔内多发性肿瘤,灰白色,质嫩．分布于肠管、大网膜、腹膜等处,肿块结节状,血径0．5～1．8cm不等。术后腹水又逐渐增多。术后病理诊断为腹腔IMT恶性变。给予顺铂、阿霉素和大剂量甲氨蝶呤治疗。化疗后1周腹水明显减少,2周后腹水消失,复奁腹部CT示腹腔内未见明显肿块。6个疗程化疗结束后患儿无肿块及腹水,目前已恢复正常生活。     

肺霍奇金淋巴瘤1例

患者,女,30岁,顺族,咳嗽伴胸痛4个月、痰中带血2周就诊。X线及CT发现左肺上叶6．3cm×6．5cm的占他性病变,B超发现腹腔有数个肿大的淋巴结,直径0．6～1．2cm。支气管镜检查见左肺上叶前支狭窄,支口有白色结节生长。质脆易出血。取局部组织活检,见纤维组织中有急慢性炎细胞浸润。临床怀疑为肺癌,遂行开胸探查、左肺上叶切除术。[第一段]     

腹腔内促结缔组织增生小圆细胞肿瘤二例

例 1男 ,18岁。因发现腹部肿块 3个月伴左上腹胀痛不适 6d ,于 2 0 0 1年 2月 10日入院。体检 :左上腹、左下腹、右中下腹部各扪及直径为 3～ 10cm不等肿块 ,其界限较清楚 ,无压痛 ,质地中硬。直肠指检 :在距肛门 3cm处扪及盆腔内巨大肿块 ,其向后推挤直肠 ,肿块质硬。B超和核磁共振检查显示腹腔内有多数大小不等团块结节占位。手术见腹膜、盆腔、左上腹、肠管旁和肠系膜有多个直径为 1～ 10cm不等肿块 ,呈灰白色 ,质硬。术中冷冻切片报告为恶性肿瘤 ,类型待定。仅取一肿块组织。患者于术后 2个月死亡。例 2男 ,38岁。因发现右下腹部迅速生…     

乳腺导管内乳头状瘤伴皮脂腺化生一例

患者女,67岁。因发现右侧乳房内鸡蛋黄大小肿块1个月于2006年2月16日入院。体检：右乳腺内上象限触及约3．0cm×3．0cm×2．0cm肿物,质硬,触之无痛感,活动度差,与周围组织界限尚清楚。无乳头溢液,双侧腋窝淋巴结未触及肿大。乳腺钼靶摄片：右乳房内上象限2．5cm×2．5cm高密度影,界限清楚,内见细小钙化灶。彩色超声检查：右乳房内上象限探及1个2．9cm×2．0cm界限清楚、实性低回声结节。近边缘处回声不均匀,探及1．0cm×0．9cm形态不规则的暗区。暗区内探及条状分隔带,未探及明显血流信号。     

隔离肺及肺完全不分叶3例

例1,男性死婴,第一胎第一产,其母31岁,孕期检查发现并经X线及B超确诊为胎儿脑积水,头盆不称,预产期前3周行剖宫术娩出。尸检:身长48cm,体重3530g,头颅前后径21cm,横径16cm,余体表检查无异常。腹腔检查见腹腔内各脏器位置及形状均无异常。胸腔检查发现左侧胸腔在肺后下方近横膈处有一扇形块状     

小肠多发性脂肪瘤伴发肠套叠一例

患者女 ,43岁。 1998年 12月 8日因 3ｄ未解大便 ,伴腹痛、恶心、呕吐 ,外院曾予庆大霉素、6 5 4 Ⅱ等药物抗炎、解痉 ,症状未能明显缓解 ,遂来我院急诊。体检 :腹软 ,脐旁压痛明显 ,无反跳痛及肌紧张 ,腹腔穿刺未抽出液体。Ｘ线示 :小肠高位绞窄性梗阻。行剖腹探查术 ,术中见小肠套叠形成约 5ｃｍ ,套叠处及远近端肠壁扪及多个肿块 ,质软 ,界清 ,大者约 3ｃｍ× 3ｃｍ ,小者直径约 0 5ｃｍ。切除病变肠段。病理检查 :小肠一段 ,长约 44ｃｍ ,粘膜、浆膜面见多枚散图 1　 小肠粘膜面可见数十个大小不等的肿块突起作者单位 :2 0 0 5 40上海…     

腹膜分化型乳头状间皮瘤一例

患者男 ,5 7岁。因腹胀半年余于 2 0 0 2年 3月 2 0日入院。患者两年半前因右腹股沟斜疝在外院手术 ,术中见疝囊壁上有多灶性白色疣状物 ,腹腔内腹膜表面也有同样表现 ,颗粒大小 0 2～ 0 5cm。病理诊断 :腹膜间皮增生。患者术后未进行任何治疗。因近半年感觉腹胀 ,逐渐明显 ,来我院诊治。腹腔镜检查见腹腔内有腹水 2 0 0ml,淡黄色 ,腹膜及大网膜上均有弥漫性粟粒样结节 ,直径 0 2～ 0 3cm。取活检。病理检查 :镜下观察病变组织呈多灶性乳头状生长 ,乳头宽窄不一 ,多数为Ⅰ～Ⅱ级乳头 ,乳头中心由疏松结缔组织和薄壁血管构成 ,部分间质纤…     

Level of functioning of siblings and parents of probands of varying degrees of retardation

A further analysis of already published data supports the position that retardates of low ability level less frequently have retarded siblings, retarded parents, and parents low in occupational level than do retardates higher in ability level. The analysis supports the position that there are two types of retarded individuals, persons retarded as a result of gene or chromosomal anomalies, brain injury, etc., who more frequently occur in the lower-level retardate group, and persons whose retardation represents polygenic segregation, who more frequently occur in the higher-level group.     

Modes of Inheritance of Errors of Refraction

Eighteen families in which both parents had refractions within the range of +4·0 D to −4·0 D and axial lengths seen in emmetropia (22·3-26·0 mm) showed coefficients of correlation of the order 0·5 indicative of polygenic inheritance. Such coefficients were seen for axial length (0·407) and for the cornea (0·487), but not for the lens (which is known to be yoked to the axial length). No such coefficients were seen in 19 families in which one of the parents had axial length outside the emmetropic range (nine families with long axes and 10 with short axes).

The pattern of polygenic inheritance for emmetropia (completely correlated optical components) and errors of refraction up to 4·0 D (inadequately correlated components: correlation ametropia) follows that seen in stature and other measurable characters. In contrast the high refractive errors with their abnormal axial lengths (component ametropia) are—like the extremes in stature—pathological anomalies with monofactorial inheritance.

     

Aspects of the problem of direct introduction of Standards of International Organizations

Editorial note. This article is published as part of a discussion. Particular issues of the article are disputable. First of all, this concerns the so-called “folder” method of introduction of international standards for medical devices to domestic medical practice (i.e., by direct translation of the standards and their publication as standardizing documents). Nevertheless, at least one of the problems, the problem of coordination between domestic state standards for medical devices and international recommendations of ISO and IEC, is undoubtedly of topical importance. Advancement of new health service legislation which is to be approved by law-makers will definitely introduce corrections into the present situation. The Editorial Board of Meditsinskaya Tekhnika believes this article will lessen these problems and to be welcomed by readers.