桥小脑角原发性恶性黑色素瘤1例报告

桥小脑角原发性恶性黑色素瘤１例报告桂开林，张恒兴，李全义空军４５６医院病理科（山东省济南市２５００３１）恶性黑色素瘤较少见，多数发生在粘膜区及皮肤，原发颅内者罕见。本文报告１例。患者女，２８岁，因耳鸣，头晕３年，有耳听力减退，走路不稳１年，于１９９４...     

跟部恶性黑色素瘤的治疗

目的 探讨跟部恶性黑色素瘤的治疗。方法 手术切除病灶后皮瓣修复皮肤缺损。术前、术后应用α－干扰素肌注免疫治疗。结果 １１例皮瓣全部成活，所有病例经６个月至５年随访均存活，未发现病灶复发或转移。结论 跟部恶性黑色素瘤进行手术切除，皮瓣修复，术后、术前应用α－干扰素治疗，取得满意疗效。     

成人髓母细胞瘤11例临床分析

背景与目的:髓母细胞瘤是好发于儿童的恶性的胚胎性神经上皮肿瘤,成人则较为少见。本文总结报道成人髓母细胞瘤的诊治方法及治疗效果。方法:回顾性分析本院2003年1月至2010年1月的11例成人髓母细胞瘤的临床表现、影像学特点、治疗措施并进行随访。结果:11例表现为颅内压增高和小脑功能受损症状。均行MR检查,位于小脑蚓部4例,小脑半球4例,小脑蚓部+小脑半球2例,桥小脑角1例。表现为T1低或稍低信号,T2和水抑制多为高或稍高信号,增强肿瘤不均匀中度强化。行手术全切除6例,次全切除5例。术后病灶局部加全中枢神经系统放疗+化疗6例,行头颅病灶局部放射治疗1例。7例患者获术后定期MR检查、随访1～8年,3例失访,1例术后放弃治疗出院。术后MR复查证实中枢神经系统原位复发并脊髓转移2例。术后2年生存率100%,5年生存率50%。结论:成人髓母细胞瘤发病率低,临床表现及放射学特点与儿童髓母细胞瘤有许多不同点,诊断相对困难,综合治疗是主要治疗手段,治疗效果不理想。     

阴茎原发性恶性黑色素瘤1例报告并文献复习

目的:探讨阴茎原发恶性黑色素瘤的生物学行为、临床病理特征、诊断、治疗方法及其预后。方法:报告1例阴茎原发性恶性黑色素瘤的诊断治疗及随访情况,并结合国内外文献进行分析。结果:本例患者肿瘤分期为Ⅰ期,行阴茎部分切除术及双侧腹股沟淋巴结清扫术,同时给予化疗及生物治疗。术后随访24 个月,体格检查正常,行盆腔 MRI 检查未见复发及远处转移。结论:阴茎原发恶性黑色素瘤临床罕见,恶性程度高,总体预后差,其确诊依靠病理,外科手术为主要治疗手段,术后结合化疗以及生物治疗可延长生存期。     

显微外科手术治疗三叉神经痛型桥小脑角胆脂瘤27例经验

背景与目的：颅内胆脂瘤多位于桥小脑角,桥小脑角胆脂瘤是继发性三叉神经痛最常见原因,本研究探讨三又神经痛型桥小脑角胆脂瘤的临床特点、有效诊断和治疗的方法。方法：回顾性总结27例三叉神经痛型桥小脑角胆脂瘤的诊治经过及疗效。结果：CT或（和）MRI确诊后行手术治疗,19例桥小脑角胆脂瘤得以全切,8例次全切,术后所有三叉神经痛及面肌痉挛完全消失,听力障碍明显好转。跟踪随访。1年后1例三叉神经痛复发。结论：三叉神经痛型桥小脑角胆脂瘤以三叉神经痛为首发症状．临床表现多不典型．年轻的患者如有三叉神经痛的症状时要高度怀疑此病,CT、MRI可提供诊断依据,常用的手术入路为枕下乙状窦后入路．手术方法得当．肿瘤切除后三叉神经痛的症状即停止。     

桥小脑角脑膜瘤的手术治疗(附88例报告)

目的 探讨桥小脑角区脑膜瘤的手术治疗方法。方法 对近20年经手术治疗的88例桥小脑角质膜瘤进行回顾性分析。结果 肿瘤全部切除68例（全切率77．3％）,大部切除20例;术后死亡6例（死亡率6．8％）。60例随访6个月－11年,46例恢复良好,8例死亡,6例复发。结论 手术治疗是桥小脑角脑膜瘤的首选治疗方法。合理选择手术入路,术中妥善处理和保护血管、神经、脑干等,以及术后正确处理并发症,配合其他辅助治疗,是提高手术疗效和患者术后生活质量的关键。     

神经内镜辅助显微手术治疗桥小脑角上皮囊肿

 【摘要】　目的　探讨神经内窥镜辅助显微手术治疗桥小脑角上皮样囊肿的优势。方法　采用颞下经幕入路神经内窥镜辅助显微手术切除桥小脑角上皮样囊肿10例，枕下入路神经内窥镜辅助显微手术治疗2例。结果　显微镜下手术后应用神经内窥镜观察，8例均有肿瘤残留，全切10例，次全切2例，术后无并发症。结论　应用神经内窥镜辅助显微手术扩大了桥小脑角区的手术视野，可以观察到手术显微镜下不易观察到的部位，减少手术创伤，提高手术疗效，降低手术危险性。     

神经内镜辅助显微手术治疗桥小脑角表皮样囊肿的安全性和可行性

目的：探讨神经内镜辅助显微手术治疗桥小脑角表皮样囊肿的安全性和可行性。方法回顾性分析行神经内镜辅助显微手术治疗的27例桥小脑角区表皮样囊肿患者资料，观察治疗效果。结果术前 CT和 MRI 检查明确显示肿瘤形态、大小、边界和血流信号情况；22例全切，5例次全切。24例临床症状明显改善，3例好转，并发症发生率为7.40％。结论神经内镜辅助显微手术治疗桥小脑角表皮样囊肿安全性和可行性均较高，可行 CT 和 MRI 扫描为手术提供信息。     

以中枢神经系统症状为首发表现的前列腺癌脑转移１例

前列腺癌主要侵犯骨盆淋巴结及躯干骨，少有脑转移，更罕见转移至桥小脑角区，并以脑部症状首发的病 例。本文报道一前列腺癌罕见桥小脑角区转移病例，患者以头晕伴右侧耳鸣及右侧面瘫为首发症状，未诉前列腺疾 病史，术前颅脑 ＭＲＩ检查发现右侧桥小脑角区占位性病变，听神经瘤可能，患者于全麻下行右侧乙状窦后入路桥小 脑角肿瘤切除术，术后病理回报示前列腺癌转移，后续行前列腺 ＭＲＩ及前列腺穿刺活检证实前列腺原发灶。患者后 续先后于泌尿外科及放疗科行内分泌及放射治疗，生存期至初发病后 １８个月。本例患者无泌尿生殖系症状，且以听 面神经缺失症状为首发，与此部位高发的神经鞘瘤难以鉴别，极易误诊，较为特殊且罕见。     

桥脑小脑角肿瘤病人手术前后的护理

桥小脑角肿瘤为颅内肿瘤好发部位之一,其中以听神经瘤最常见。由于桥小脑角及其周围解剖关系复杂,肿瘤常累及第Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅵ对后组颅神经,甚至压迫脑干,造成梗阻性脑积水,所以此项手术难度较大,术前、术后护理要求较高。我科自1987年～1991年3月共收治桥小脑角肿瘤54例,现将护理体会报告如下。     

仙人掌原液毒性的初步研究

背景与目的： 研究仙人掌原液的毒性。 材料与方法： 小鼠急性毒性试验、Ames试验、小鼠骨髓嗜多染红细胞微核试验、小鼠精子畸形试验、大鼠30 d喂养试验。 结果： 仙人掌原液雌、雄小鼠LD50均大于20.0 g/kg,属无毒物质;Ames试验、微核试验和精子畸形试验结果均为阴性;大鼠30 d喂养试验结果显示该样品30 d喂养对大鼠各项观察指标未见毒性作用。结论： 在本次实验条件下,仙人掌原液为无毒物质,未显示有遗传毒性和亚急性毒性作用。     

食管平滑肌瘤10例临床治疗体会

我院１９７５年６月～１９９０年７月共收治食管平滑肌瘤１０例，占同期食管肿瘤总数的０．１９２％（１０／１０９２）。位于食管上段２例，中段５例，下段３例。Ｘ线食管钡餐造影是诊断本病的主要方法。行食管粘膜外肿瘤摘除９例，食管部分切除１例，效果良好。本文就其诊断与手术治疗进行了讨论。     

中晚期贲门癌148例的外科治疗

目的　总结贲门癌手术治疗影响生存率的因素 ,提供今后工作参考。方法　对 14 8例经手术治疗的贲门癌患者进行术后并发症、绝对生存率的X2 检验。结果　本组切除率为 94.5 9% ,近半胃切除占 72 .14 % ,1、3、5年生存率分别为 67.9%、45 %和 2 4.3 %。病期、外侵程度和淋巴结转移等因素对 5年生存率有显著影响 (P <0 .0 1)。术后并发症以吻合口瘘及肺癌并发症为多见 ,其发生率为 3 .6% ,手术死亡率 1.4%。结论　提高生存率的关键在于早期诊断 ,根治手术和术后积极综合治疗。     

仙人掌原毒性的初步研究

背景与目的:研究仙人掌原液的毒性。材料与方法:小鼠急性毒性试验、Ames试验、小鼠骨髓嗜多染红细胞微核试验、小鼠精子畸形试验、大鼠30 d喂养试验。结果:仙人掌原液雌、雄小鼠LD50均大于20.0 g／kg,属无毒物质;Ames试验、微核试验和精子畸形试验结果均为阴性;大鼠30 d喂养试验结果显示该样品30 d喂养对大鼠各项观察指标未见毒性作用。结论:在本次实验条件下,仙人掌原液为无毒物质,未显示有遗传毒性和亚急性毒性作用。     

胆囊癌29例分析

目的探索胆囊癌的防治方法。方法分析29例胆囊癌病人临床资料、治疗方法及结果。结果术前诊断明确者21例，剖腹探查发现已属晚期，9例为Ⅳ期行根治术，12例为Ⅴ期未行根治术，均于术后1年内死亡。术前怀疑胆囊癌者5例，剖腹探查冰冻切片证实为Ⅴ期及Ⅳ期者各1例，Ⅴ期未行根治术，Ⅳ期行根治术，均于术后1年内死亡；Ⅲ期者3例，行胆囊癌根治术分别于术后10月、13月、17月死亡。2例术中冰冻切片发现的Ⅱ期胆囊癌，行胆囊癌根治术，分别于术后23月、26月死亡。1例意外胆囊癌属Ⅰ期胆囊癌，术后5年半死亡。结论要减少胆囊癌危害，重在及时治疗胆囊结石。     

恶性肿瘤肝转移假性肝硬化发生机制及诊疗的研究进展

随着对恶性肿瘤的深入研究,越来越多的肿瘤患者接受到更规范更多线的治疗.更多线的化疗及靶向治疗,使一部分恶性肿瘤肝转移患者的肝脏发生类似肝硬化的形态学及临床改变,称之为假性肝硬化.由于假性肝硬化罕见,对于它的认识多来自于个案报道.因此,本文通过综述国内外关于假性肝硬化的个案报道及相关研究,对其发生机制、影像学及临床表现和...     

Clinico-Pathological Study of 50 Cases of Tumours of Larynx

Otoacoustic emissions have been advocated in the management of otitis media with effusion. However, otoacoustic emissions cannot differentiate different types of hearing loss. This study was conducted to find factor that can differentiate otitis media with effusion from other common causes of hearing loss in children. Children were enrolled in the study and divided in four groups consisting of 25 ears each after pure tone and impedance audiometry: (1) Otitis media with effusion group, (2) Normal ear group, (3) Sensory-neural hearing loss group, (4) Chronic suppurative otitis media group. Otoacoustic emissions were recorded and results were analyzed statistically. The normal hearing group had significant difference from other groups but total band reproducibility of transient evoked otoacoustic emissions did not show any statistical difference in the cases groups. In distortion product otoacoustic emissions, group 1 showed significant difference from group 3 and group 1 had significant difference from all other groups at 4 kHz. The study did not find any factor that differentiates otitis media with effusion from other diseases. Although, distortion product otoacoustic emissions can indicate otitis media with effusion but impedance audiometry should be the main tool in the management of otitis media with effusion.     

Management of intracranial metastases of differentiated carcinoma of thyroid

Summary Brain metastases in differentiated carinoma of the thyroid is a rare occurrence. We treated five documented cases of carcinoma of thyroid with brain metastases out of 400 cases of thyroid cancer treated between 1972 to 1993. 4 were females out of which one was pregnant during the appearance of brain metastases. All cases were treated with thyroidectomy, and radioiodine as primary therapy. Brain metastases developed 6 months to 11 years following treatment of the primary and were treated with radiotherapy and suppressive levothyroxine. We observed the beneficial effect of suppressive thyroxine and the poor prognosis associated with pregnancy and withdrawl of thyroid replacement therapy. 3 of the 5 patients are alive 12–23 months after treatment for brain metastases, while 2 patients died at 4 months and 7 years post brain metastases due to pulmonary and hepatic failure, respectively.     

Predictors of malignant potential of cystic lesions of the pancreas

Background

Cystic lesions of the pancreas (CLP) are a diagnostic dilemma, the correct characterisation of which determines surgical management.

Methods

From 1995 to 2005, radiology and pathology records were reviewed for the presence of CLP. CLP were divided into three groups; Group 1: Benign, Group 2: Pre-malignant, and Group 3: Malignant.

Results

Seventy-nine of 121 patients were included [Group 1: n = 46, Group 2: n = 10, Group 3: n = 23], with a median age at diagnosis of 68 (31–92) years. The median follow-up period was 24 (14–84) months. On univariate analysis, female gender (p = 0.04), jaundice (p < 0.01), raised serum ALT concentration (p = 0.03), cyst size (≥2.5 cm) (p < 0.01), and biliary duct dilatation (p < 0.01) were associated with malignant potential. Benign cysts were more likely to present incidentally (p < 0.01). On multi-variate analysis, cyst size (≥2.5 cm) was an independent predictor of malignant potential. Sub-group analysis revealed that cysts < 2.5 cm in the head of the pancreas with evidence of biliary obstruction (either abnormal liver function; raised ALT [p = 0.01], ALP [p = 0.01], total bilirubin [p = 0.02], and/or biliary duct dilatation [p < 0.01]) were associated with malignant potential.

Conclusion

Cyst size ≥2.5 cm on computer tomography imaging was an independent predictor of pre-malignant and malignant pancreatic cysts. Cyst size and the presence of biliary obstruction predict potentially malignant cysts of the head of the pancreas, which require surgical management.