嗜酸性膀胱炎3例报告并文献复习

目的:探讨嗜酸性膀胱炎的临床诊断和诊治方法.方法:回顾性分析3例嗜酸性膀胱炎患者临床资料,并结合相关文献综合分析讨论本病病因学、诊断和治疗.结果:3例患者起病均有膀胱下尿路刺激症状、镜下或肉眼血尿,B超见膀胱壁增厚和(或)膀胱新生物.经膀胱镜检查并活检确诊为嗜酸性膀胱炎.其中1例患者经电切后口服抗感染、抗过敏药物后好转,1例考虑为寄生虫感染患者加用抗寄生虫药物后好转;1例病灶电切后反复发作,经仔细追问病史,患者有虾蟹过敏史,经抗过敏及禁食虾蟹后未再发作.随访18～128个月,平均随访72个月,预后良好.结论:嗜酸性膀胱炎确诊需要膀胱镜检查及组织活检.治疗上以消除病因,切除病变组织和抗炎、抗过敏等治疗方法.本病容易复发,需要长期强制性随访.     

Head and neck reconstruction: a review of 117 cases

The reconstruction of defects of the head and neck, no matter the cause, begins with a careful assessment of the patient and the defect. Ideally, it ends with the successful execution of the reconstructive procedure that optimally restores form and function with minimal morbidity. There are several treatment possibilities that differ in their indications, technical difficulty, safety, and incidence of complications. This is a review over a period of 13 years of 117 cases of head and neck reconstruction performed by the author. Sixty-eight patients were treated with five different musculocutaneous pedicled flaps, mainly during the first half of the 13-year period. Those based on the pectoral major and latissimus dorsi were the most frequently utilized, mainly in pharyngolaryngeal reconstructions and sometimes as osteomyocutaneous flaps for oromandibular defects. Forty-nine patients had microvascular reconstructive procedures with 12 different types of free flaps. The latissimus dorsi flap was used for reconstruction of the scalp and after excision of intracranial lesions, whereas the serratus anterior or rectus abdominis free flaps were utilized for reconstruction of complex defects of the middle-third of the face. The radial forearm flap and the free jejunum have become the choice for intraoral and pharyngoesophageal reconstruction, respectively. Good results were obtained in both functional and social rehabilitation of the patients. There were three flap losses due to thrombosis of the microvascular anastomosis. There was no surgical mortality. The indications for each pedicled and free flap are discussed. Received: 27 October 1999 / Accepted: 22 June 2000     

Acute ischemic gangrene of the rectum: Report of 3 cases and review of literature

INTRODUCTIONAcute ischemia of the rectum resulting in full thickness necrosis is extremely uncommon because of its excellent blood supply.PRESENTATION OF CASEWe present 3 cases with spontaneous ischemic gangrene of the rectum. All three patients were elderly with atherosclerotic arterial disease and presented with hypotensive shock but in none of these patients we encountered a precipitating factor such as preceding vascular surgery or shock state.DISCUSSIONA high index of suspicion should be maintained in elderly patients with atherosclerotic disease who present with lower GI symptoms with hypotensive shock and an inflamed rectum on CT scan. Immediate beside proctoscopy should be offered to these patients and if the diagnosis is confirmed these patients should be taken to the operating room immediately. If the entire rectum is found to be gangrenous then an emergency APR should be performed and the perineal wound left open. If the rectum is partially gangrenous then a low anterior resection with Hartman's procedure for diversion is appropriate.CONCLUSIONPrompt diagnosis and resuscitation followed by immediate surgical intervention is necessary to save these elderly patients.     

成人双侧睾丸扭转病例分析并文献复习

目的:报告3例成人双侧睾丸扭转并复习文献。方法:回顾性分析3例双侧睾丸扭转因误诊致睾丸坏死的病例,结合国内外文献对睾丸扭转发病原因、解剖分类、临床表现、超声诊断和治疗方案进行复习和讨论。结果:3例因误诊后致双侧睾丸坏死,后均经双侧睾丸彩色多普勒超声确诊后行双侧睾丸切除术。结论:发病后及时就诊,首诊医师的高度重视、准确诊断、正确处置是挽救睾丸的关键;彩色多普勒超声检查仍然是确认阴囊急症的首选辅助检查;对疑为睾丸扭转者,应急诊手术探查。     

Laryngeal melanosis: Report of four cases and literature review

OBJECTIVE: Laryngeal melanosis is a rare condition defined by the presence of melanocytes within the laryngeal epithelial lining. Our aims were (1) to review our cases together with those in the literature, and (2) to determine whether melanocyte incidence is increased with exposure to irritant stimuli such as tobacco.METHODS: A retrospective study of all cases diagnosed with laryngeal melanosis in our hospital from January 1, 1990, to December 31, 1996, was accomplished. To determine the melanocyte incidence in the normal larynx as well as the influence of tobacco in development of laryngeal melanosis, 16 age-matched controls, 8 of whom were smokers and 8 of whom were not, were chosen, and a histochemical and immunohistochemical study was performed. The following antibodies were used: S-100 protein, CD1a, and HMB-45. A comparative study of the melanocyte incidence between patients with laryngeal melanosis and the controls was carried out. Also, a comparative study between smoking and nonsmoking patients was performed.RESULTS: Laryngeal melanosis was diagnosed in 4 patients at our hospital during this period of time. In the comparative study, the number of melanocytes in the 4 patients with laryngeal melanosis was higher than in the 8 smoking ( p < 0.01, Mann-Whitney U test) and 8 nonsmoking ( p < 0.01) controls, and there was a trend toward a higher number of melanocytes in the 8 smoking patients than in the 8 nonsmoking ( p = 0.064) controls.CONCLUSIONS: Laryngeal melanosis was more frequent in smoking men older than 50 years. Our observations underline the association of LM with larynx carcinoma and its relation to a stimulus such as tobacco. In fact, we have found activated melanocytes in our cases of laryngeal melanosis. They were identified by immunoreactivity for HMB-45. (Otolaryngol Head Neck Surg 1997;117:708-12.)     

Pituitary abscesses: Report of two cases and review of the literature

Summary Two cases of pituitary abscess are reported. Bacteriological and histological findings of both cases are discussed, together with data available from the literature.     

Cystic pneumatosis of the colon. Report of 3 cases and review of the literature

Pneumatosis cystoides intestinalis (PCI) is a rare entity in which gas is found in cysts located in the intestinal wall. PCI is a sign, not a disease; therefore, its relevance should be interpreted within the whole clinical context. PCI has been found in several distinctive clinical settings, which the authors review in the light of their 3 new cases. Morphologic and endoscopic examinations showed "polypoid" intraluminal formations corresponding to pneumocysts which should not be misdiagnosed with a diffuse polyposis. The most important tasks of the physician include: 1) recognition of the entity of PCI so that patients are not misdiagnosed and mismanaged as having malignancy or polyposis; and 2) differentiation of the benign noncomplicated cases from life-threatening forms (bowel necrosis, perforation, and infections), in which immediate surgery is necessary, and which are associated with high mortality.     

Head and neck desmoid tumor in children: a case report and review of the literature

We report a case of desmoid tumor in the submandibular region in an 18-month-old girl. Head and neck desmoid tumors are uncommon in children and diagnosis is a difficult task because the tumors are often classified as different types of fibromatosis. This histologically benign affection is characterized by local expansion or destruction and tends to recur. Pathology gives the positive diagnosis, showing fibroblastic monoclonal proliferation between the cellular center and the collagen periphery. Electron microscopy evidences an abundant collagen network enclosing a polymorphous cellular proliferation. Immunohistochemistry defines vimentin and actin positive desmoid tumors. Surgery is usually the therapeutic choice. Chemotherapy and radiotherapy may be used in conjunction with surgery in situations of recurrence or unsatisfactory surgical margin. There is a risk of recurrence which can be detected with regular follow-up examinations.     

Fournier's gangrene: Report of thirty-three cases and a review of the literature

Background: Fournier’s gangrene (FG) is an extensive fulminant infection of the genitals, perineum or the abdominal wall. The aim of this study is to share our experience with the management of this difficult infectious disease. Methods: Thirty‐three male patients were admitted to our clinic with the diagnosis of FG between February 1988 and December 2003. The patient’s age, etiology and predisposing factors, microbiological findings, duration of hospital stay, treatment, and outcome were analyzed. The patients were divided into two groups. The first 21 patients (Group I) were treated with broad‐spectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning, and then they underwent split‐thickness skin grafts or delayed closure as needed. The other 12 patients (Group II) were treated with unprocessed honey (20–50 mL daily) and broad‐spectrum triple antimicrobial therapy without debridement. Their wounds were cleaned with saline and then dressed with topical unprocessed honey. The wounds were inspected daily and the honey was reapplied after cleaning with normal saline. Then, the patients’ scrotum and penis were covered with their own new scrotal skin. Results: The mean age of the patients was 53.9 ± 9.56 years (range = 23–71). The source of the gangrene was urinary in 23 patients, cutaneous in seven patients, and perirectal in three patients. The predisposing factors included diabetes mellitus for 11 patients, alcoholism for 10 patients, malnutrition for nine patients, and medical immunosuppression (chemotherapy, steroids, malignancy) for three patients. The mean duration of hospital stay was 41 ± 10.459 (range = 14–54) days. Two patients in Group I died from severe sepsis. The clinical and cosmetic results were better in Group II than Group I. Conclusions: Necrotizing fasciitis of the perineum and genitalia is a severe condition with a high morbidity and mortality. Traditionally, good management is based on aggressive debridement, broad‐spectrum antibiotics, and intensive supportive care but unprocessed honey might revolutionize the treatment of this dreadful disease by reducing its cost, morbidity, and mortality.     

睾旁胚胎型横纹肌肉瘤5例报告并文献复习

目的:提高睾旁胚胎型横纹肌肉瘤的诊治水平。方法:回顾性分析5例睾旁胚胎型横纹肌肉瘤患者的临床资料,结合文献复习进行讨论。结果:5例患者中精索胚胎型横纹肌肉瘤2例、附睾胚胎型横纹肌肉瘤2例、鞘膜横纹肌肉瘤1例,临床病理分期Ⅰ期2例,Ⅱ期1例,Ⅳ期2例。5例患者最终均行根治性睾丸切除术及肿块完整切除术。1例Ⅰb期和1例Ⅱ期患者术后采用异环磷酰胺、长春新碱、足叶乙甙、丝裂霉素、顺铂化疗并配合局部放疗,余3例未行进一步治疗。2例Ⅰ期、1例Ⅱ期患者随访28、18、12个月未见复发和转移,1例Ⅳ期患者随访6个月后死于多发转移,1例Ⅳ期随访6个月未见复发和转移,后失访。结论:早期诊断,根治性手术并辅助化疗、放疗是治疗睾旁胚胎型横纹肌肉瘤的有效手段。     

膀胱小细胞癌3例报告并文献复习

目的:探讨膀胱小细胞癌(BSCC)的临床特征、病理学特征和诊治方法。方法:回顾性分析3例BSCC的临床资料。3例均为男性,年龄68~82岁,2例有间断无痛性肉眼血尿,1例有尿频尿急。1例B超检查见膀胱内有1.5cm×0.9cm稍强回声区,后伴弱声影,中心回声较低;1例膀胱镜检查见膀胱颈10~12点处有1cm×1cm乳头状突起,无蒂,广基,呈地毯样生长;1例盆腔CT及加强扫描示膀胱内有类圆形团块状影,大小约2.5cm×2.6cm。2例行经尿道膀胱肿瘤电切术,1例行膀胱部分切除术。结果:术后病理检查均报告为膀胱小细胞未分化癌。免疫组织化学结果:嗜铬蛋白颗粒均( ~ ),神经特异烯醇化酶均(-~±),例1突触素(-),例2突触素( ),例3突触素( ~ )。例1术后3年复发,患者拒绝行根治性膀胱全切术,服中药治疗10个月后死亡。例2术后8个月因膀胱小细胞癌转移而死于全身衰竭。例3术后病理检查结果为膀胱移行细胞癌2~3级,部分为小细胞未分化癌,局部伴腺样分化,3个月后复发,行根治性膀胱全切加双侧输尿管皮肤乳头术,术后随访15个月无肿瘤复发。结论:BSCC是一种少见的高度恶性的膀胱肿瘤,诊断主要靠病理学检查,早期即可发生转移,预后较差。行根治性切除术加联合化疗可提高治愈率。     

重复膀胱2例报告并文献复习

目的：提高对重复膀胱的认识及诊疗水平。方法：回顾性分析2例重复膀胱患者的临床资料。2均为女性,年龄21和27岁。分别以下腹部不适和尿频、尿痛就诊。术前诊断1例为左肾萎缩、左输尿管下段张;另1例为膀胱憩室,并发膀胱结石继发感染。结果：1例术中发现左输尿管下端连接一个肌性囊袋,此囊袋与一个盲管相连,将此囊袋和盲管与左肾和输尿管一并切除,病理检查诊断为重复膀胱尿道,左肾萎缩;另1例中见膀胱被一个肌性中隔分为左右两腔,借中隔中下部孔互相连通,切除的中隔病理检查为膀胱组织。2例均术后8天痊愈出院,随访无异常。结论：重复膀胱罕见,常并发其他器官发育异常。影像学检查可为诊断提供助,手术是唯一能根治的方法。     

原发性输尿管鳞状细胞癌的临床特征(附3例报告并文献复习)

目的:探讨原发性输尿管鳞状细胞癌(USCC)的临床特征。方法:报告3例USCC患者的临床资料,均无痛性肉眼血尿为首发症状,合并腰腹部疼痛,2例CT或MRI术前诊为原发性输尿管癌,1例术中冰冻病检确诊;3例皆行肾、输尿管及膀胱袖套样切除术,病理提示3例皆为高分化USCC,其中1例合并腺癌。结果:1例术后6个月死亡,2例术后行放疗,分别存活19个月和26个月。结论:USCC高度恶性,诊断时已为临床晚期,预后差,手术当强调行肾蒂至髂血管远端淋巴结清扫,术后建议定期放疗。     

True infrapopliteal artery aneurysms: Report of two cases and literature review

Aneurysms of the infrapopliteal arteries are rare and commonly associated with trauma. Most appear as false aneurysms. Because they are quite rare events, we describe for the first time in the English-language literature two cases of a combination of true aneurysms of the popliteal and tibial arteries. Symptoms at initial examination are calf mass and distal ischemia. Clinical features, radiographic findings, surgical management, and a review of the literature on true infrapopliteal aneurysms are discussed. (J Vasc Surg 1996;24:276-8.)