原发性上尿路非移行细胞癌12例分析

目的:探讨原发性上尿路非移行细胞癌的临床特点及预后.方法:结合文献回顾性分析12例原发性上尿路非移行细胞癌临床和病理资料.结果:12例中伴血尿症状8例,泌尿系结石病史7例,慢性肾盂肾炎病史1例,生化武器接触史1例.B超下平均大小:肾盂占位6.2 cm×4.3 cm,输尿管占位2.9 cm×1.1 cm.输尿管镜检2例,发现肾盂、输尿管肿瘤各1例.患者均接受手术治疗,病理示肾盂鳞癌4例,腺癌1例;输尿管鳞癌6例,腺鳞癌1例.9例于18个月内死亡,中位生存期10.3个月.结论:原发性上尿路非移行细胞癌临床罕见,一般认为与泌尿系结石感染等长期刺激因素有关,常分期较晚,预后差.     

原发性输尿管癌26例临床分析

目的:探讨原发性输尿管癌的早期诊断及治疗.方法:对1990年2月-2004年10月收治的26例输尿管癌进行回顾性分析.结果:26例术后病理检查证实为输尿管移行乳头状细胞癌,其中A期3例,B期15例,C期5例,D期3例,G1级7例,G2级15例,G3级4例.随访23例,随访时间6个月～12年,总的5年生存率为52.17%;根治性与保守性手术后生存率分别为52.94%和50%;根治性手术后膀胱癌的发生率为23.53%,低于保守性手术后的发生率(50%).结论:原发性输尿管癌的预后主要取决于肿瘤的分期分级,进一步提高早期诊断并及时正确的治疗是提高患者生存率的关键.     

原发性尿道移行细胞癌的诊治体会(附2例报告及文献复习)

目的：探讨原发性尿道移行细胞癌的诊断治疗。方法：分析2例原发性尿道移行细胞癌患者的临床资料,结合文献复习讨论。结果：2例患者病理报告为移行细胞癌1级。1例B期患者1例A期患者术后灌注BCG两疗程后随访两年无复发,结论：原发性尿道移行细胞癌是一种罕见的恶性肿瘤,确诊需依赖组织病理学。     

肾结石并发肾盂鳞状细胞癌漏诊4例分析

目的分析肾结石并发肾盂鳞状细胞癌的诊断及治疗。方法分析4例肾结石合并肾盂鳞状细胞癌的临床诊治资料。结果 4例患者中,1例超声CT、IVU术前提示肾盂肿瘤,1例行PCNL术中发现肾盂肿物,活检示肾盂鳞癌,2例术后病理证实鳞癌。术后3例获得随访,1例6个月后死亡,2例存活2~5 a。结论本病临床缺乏特异性,漏诊率高,诊断较困难。     

膀胱移行细胞癌术前CT与病理分期对照分析

目的:探讨膀胱移行细胞癌术前CT分期和术后病理分期诊断的错误原因及改正方法。方法:50例经手术、病理证实的膀胱移行细胞癌患者均行CT平扫和增强扫描。按TNM法分期。结果:术前CT分期结果:T1期13例,T2期17例,T3a期7例,T3b期5例,T4期6例,漏诊1例,无法评估1例。手术及病理分期结果:P1期16例,P2a期22例,P2b期5例,P3期2例,P4期5例。CT分期与病理符合者34例。16例CT分期与病理分期不相符合,其中分期过低者(CT分期低于病理分期)1例;漏诊1例;1例CT不能分期诊断;分期过高者(CT分期高于病理分期)13例。CT分期诊断准确率为82%(41/50)。病理分期诊断准确率为86%(43/50)。结论:CT对T3b期和T4期膀胱癌的分期诊断准确。膀胱癌临床分期需在病理诊断的基础上,充分结合CT等影像资料,综合判断以提高分期诊断的准确率。     

长期血液透析患者合并尿路上皮恶性肿瘤(附14例报告)

目的 探讨长期血液透析患合并尿路上皮恶性肿瘤的临床表现、诊断和治疗方法。方法 回顾性分析14例长期血液透析患合并尿路上皮恶性肿瘤的临床资料。患的主要临床表现为肉眼血尿伴有血块，经B超、膀胱镜、CT、MRU检查可明确诊断。12例患行手术治疗，2例患未行手术。其中6例膀胱全切患采用了肾和输尿管旷置。结果 肾盂癌3例，输尿管癌l例，膀胱癌10例，其中膀胱移行细胞癌7例，鳞癌1例，腺鳞癌1例，未分化癌1例，TNM分期：Tl期2例，T2期3例，T3期5例，盆腔淋巴结转移2例。7例移行细胞癌分级为：Ⅱ级4例，Ⅲ级3例。14例患均获随访，随访时间8—48个月，平均23个月，死亡5例，9例存活患均未见肿瘤复发。结论 长期血液透析患合并尿路上皮恶性肿瘤发病率高，手术是主要治疗方法。     

容易误诊的浸润性肾盂癌6例分析

目的：探讨浸润性肾盂癌的临床表现、影像学特征、诊断及治疗。方法：浸润性肾盂癌患者6例，B超和CT诊断为肾囊肿合并感染、大叶性肾炎或。肾癌。结果：6例患者均接受了手术，术后病理回报为乳头状浸润型移行细胞癌Ⅱ～Ⅲ、Ⅲ级，T3、T4期肿瘤各3例。结论：浸润性肾盂癌往往临床和影像学表现不典型，常误诊为肾实质炎症或肾实质肿瘤。不能除外肾盂癌时，可以行一侧肾、输尿管全长＋膀胱袖套状切除。     

原发性输尿管癌的诊断和治疗

目的：提高原发性输尿管癌的诊断与治疗水平．方法：对1993～2002年收治28例原发性输尿管癌进行随访,分析其临床表现、影像学特点、手术方式、病检结果及预后：结果：本组28例,肉眼血尿21例,占75％;肾绞痛4例,占14％;腰痛17例,占61％经影像学榆查发现异常后,均通过手术治疗。术后病理证实为移行细胞癌。其中5例生存小足一年(3例Ⅳ期、G3级;2例Ⅲ期、G3级);生存5年以上4例,均为Ⅰ期G1级：结论：原发性输尿管癌的预后主要与肿瘤的分级、分期密切相关,运用综合诊断措施可使原发性输尿管癌获得早期诊断和治疗。     

鼻腔原发性恶性肿瘤的ＣＴ诊断价值

鼻腔原发性恶性肿瘤临床少见,约占全身恶性肿瘤的1%～2%[1]。笔者搜集本院近8年来经病理证实的鼻腔原发性恶性肿瘤21例,分析其CT表现,探讨CT诊断价值。1材料与方法1998年1月～2005年11月行CT扫描并经病理证实的鼻腔原发性恶性肿瘤患者21例,男11例,女10例,年龄39～80岁,中位年龄60岁。病程1月～3年。临床表现为进行性鼻塞、血涕、鼻出血、鼻背或鼻翼肿物、嗅觉减退、突眼、发热、消瘦等。发病部位:右侧9例,左侧8例,中隔2例,双侧2例。病理类型:非霍奇金淋巴瘤10例,其中外周T细胞淋巴瘤4例,TJNK细胞淋巴瘤5例,B细胞性淋巴瘤1例;鼻腔癌6例,…     

CT和MRI对输尿管移行细胞癌的诊断价值

目的探讨输尿管移行细胞癌的CT和MRI表现及诊断价值。方法回顾性分析输尿管原发性移行细胞癌15例,其中11例作CT检查,9例作MRI检查。所有患者均经手术病理证实。结果MRI或CT表现为腔内软组织肿块8例,沿管壁浸润生长5例,向腔外生长2例。CTU或MRU表现为充盈缺损或输尿管中断,梗阻以上输尿管及肾盂扩张,注射对比剂后肿瘤轻到中度强化。结论CT和MRI可早期发现输尿管肿瘤,明确其部位及范围,可准确进行肿瘤分期。     

肾结石合并肾盂鳞状细胞癌的早期诊断与治疗(附2例报告)

目的 探讨肾结石合并肾盂鳞状细胞癌的早期诊断与治疗.方法 报告肾结石合并肾盂鳞状细胞癌2例,结合相关文献探讨其早期诊断及治疗方法.结果 2例均有典型肾绞痛病史及合并血尿,CT检查提示肾盂癌2例.2例术中经冰冻病理确诊后,行根治性患肾切除术,1例术后行全身化疗,5个月后死于全身衰竭,另一类术后随访18个月无复发.2例病理诊断均为鳞状细胞癌.结论 肾结石合并肾盂鳞状细胞癌恶性程度高、预后差,临床表现缺乏特异性,易误诊和漏诊,提高对本病的认识,对可疑病例进行多项必要的辅助检查,有助于明确诊断.治疗以根治性患肾切除为主.     

切口脂肪层下引流在妇科腹部手术中的应用

腹部手术切口延期愈合，不仅给受术者带来痛苦和精神压力，增加医疗费用的支出，而且在医患关系紧张的环境下，增加了医疗纠纷。为了预防切口感染，促进切口愈合，笔者对40例接受妇科手术者，行腹部切口脂肪层下放置橡皮引流片引流，无一例切口延期愈合，取得良好的临床疗效。现报告如下。     

肾结石合并肾盂鳞状细胞癌的早期诊断与治疗（附2例报告）

目的探讨。肾结石合并。肾盂鳞状细胞癌的早期诊断与治疗。方法报告肾结石合并肾盂鳞状细胞癌2例,结合相关文献探讨其早期诊断及治疗方法。结果2例均有典型肾绞痛病史及合并血尿,CT检查提示肾盂癌2例。2例术中经冰冻病理确诊后,行根治性患肾切除术,1例术后行全身化疗,5个月后死于全身衰竭,另一类术后随访18个月无复发。2例病理诊断均为鳞状细胞癌。结论肾结石合并肾盂鳞状细胞癌恶性程度高、预后差,临床表现缺乏特异性,易误诊和漏诊,提高对本病的认识,对可疑病例进行多项必要的辅助检查,有助于明确诊断。治疗以根治性患。肾切除为主。     

Thiazolidinediones and progression of renal disease in patients with diabetes.

OBJECTIVE: Thiazolidinediones (TZDs) are used in the treatment of type 2 diabetes mellitus (T2DM) and appear to have beneficial effects on markers of cardiovascular or renal risk that are independent of glycemic control. We examined the effects of TZDs on renal survival in a predominantly black population with T2DM. METHODS: We performed a retrospective case-control study in patients with T2DM seen in our nephrology clinic in 2001 to 2002. Cases had T2DM and were on a TZD at presentation or for >or= 6 months over follow-up. Controls were matched for sex, age, duration of T2DM, and initial creatinine. Reaching end-stage renal disease (ESRD) was the primary end point. RESULTS: From 387 records, 43 cases (34 blacks, 31 females) and 106 controls (96 blacks, 83 females) were identified. The baseline characteristics were similar for both groups. Both groups had moderate renal disease (estimated glomerular filtration rate approximately 40-45 mL/min). Cases had lower systolic blood pressure over follow-up (p=.02), but there was no difference in glycemic control or use of insulin. Renal survival was better among cases (age- and gender-adjusted odds ratio for reaching ESRD 0.17 [95% confidence interval 0.03-0.8]; p=.03). When adjusted for systolic blood pressure over follow-up, the tendency for improved renal survival in cases remained but was no longer significant. CONCLUSION: We conclude that TZDs may protect against the progression of renal disease in T2DM. Prospective studies are required to determine the effects of TZDs on renal survival in T2DM.     

Hypoechoic normal renal sinus and renal pelvis tumors: sonographic differentiation.

OBJECTIVE: To evaluate the sonographic findings of an unusually hypoechoic renal sinus that mimics a tumor in the renal pelvis or renal sinus. METHODS: Sonographic scans of 7 patients with an unusually hypoechoic portion in the renal sinus were reviewed retrospectively. Computed tomography, excretory urography, or both confirmed all sinuses as normal. Five consecutive cases of renal pelvis tumors, which were detected on sonography initially in same period, were also reviewed to determine the differences between the 2 conditions. All cases were transitional cell carcinomas of the renal calyces. The images were analyzed for location, shape, margin, presence of posterior sonic attenuation, and associated findings such as caliectasis. RESULTS: Sonographic findings noted in patients with hypoechoic normal renal sinuses were irregular and poorly defined margins (n = 7), a central and symmetric location in the renal sinus (n = 6), the presence of posterior sonic attenuation with nonvisualization of the posterior border of the lesion (n = 7), an unaffected peripheral hyperechoic renal sinus (n = 7), and traversing hilar vessels in the lesion on color Doppler sonography (n = 7). In contrast, renal pelvis tumors had a relatively well-defined margin (n = 4), an eccentric location in the renal sinus (n = 2), a partially or completely obliterated hyperechoic renal sinus (n = 2), a visible posterior margin (n = 5), no posterior shadowing (n = 5), vessel displacement by the mass on color Doppler sonography (n = 5), and associated caliectasis (n = 1). CONCLUSIONS: By being familiar with the sonographic characteristics of a hypoechoic renal sinus, it can be differentiated from renal pelvis tumors, and unnecessary diagnostic workups can be avoided.     

原发性脑淋巴瘤的CT和MRI观察

目的:探讨原发性脑淋巴瘤的CT、MRI表现。材料与方法:回顾性分析25例未经治疗的原发性脑淋巴瘤的临床、病理及CT、MRI表现。结果:25例患者共计35个病灶,其中16例患者(19个病灶)同时作MRI检查,所有病灶CT平扫为等或稍高密度,T1WI为等、低信号,其中5个病灶伴局灶性高信号;12个病灶在T2WI上为等、低信号;14个病灶DWI为等、高信号。所有病灶均有增强,18个病灶为均匀增强。13例病理检查,病灶表现为瘤细胞密集、高核浆比,病灶内出血坏死少见。结论:免疫功能正常状态原发性脑淋巴瘤的CT、MR表现有一定特征性,但鉴别诊断仍需仔细谨慎。     

Effectiveness of brachytherapy in the treatment of lip cancer: A retrospective study at the Istanbul University Oncology Institute

Stage T1 through T3 lip cancers can be treated primarily by brachytherapy (BRTX), with or without external radiotherapy (ERT), with adequate safety margins and good results. In this study, the outcomes of BRTX were reviewed for patients treated at the Brachytherapy Department of the Istanbul University Oncology Institute (IUOE). The medical records of 41 patients registered at IUOE with a diagnosis of lip cancer between 1988 and 2003 were reviewed. The median follow-up time was 88 months (24–160 mo). Among these patients, 21 patients with a primary tumor, 14 with tumors arising postoperatively, and 6 with postoperative recurrence of tumor were treated using BRTX. A total of 33 patients (80%) received BRTX alone and 8 (20%) received BRTX and ERT. The 10-year local control rate was 100%, 93%, and 67% for patients treated with BRTX alone, BRTX and surgery, and those treated for postoperative recurrence, respectively (P < .02). For patients treated with BRTX only and BRTX plus surgery, specific disease-free survival was 95% and 94%, respectively, and overall survival was 93% and 100%, respectively; these differences were not statistically significant. One patient with a postoperative recurrence who had been treated with BRTX died as a result of lip cancer. No patients developed any ulcerations, intra-oral complications, or mandibular necrosis. In the BRTX only group, 83% had excellent or good cosmetic results. In the surgery group, 62% had a contour deformity. In lip cancer management, BRTX results were comparable for local control, survival, and minimal late effects in normal tissue. This is in accordance with current reports in the medical literature. Satisfactory results were observed in patients with stage T1 and T2 lesions who had been treated with BRTX only and in patients with stage T3 lesions who had been treated with BRTX plus ERT, without a need for additional treatment modalities.     

Atypical exocrine and endocrine pancreatic tumors (anaplastic, small cell, and giant cell types): CT and pathologic features in 14 patients

BACKGROUND: Our purpose was to review a series of 14 patients with atypical exocrine and endocrine pancreatic tumors to derive characteristic computed tomographic and pathologic features that might allow better diagnosis, categorization, and management of these patients. METHODS: Medical records from several university medical centers were reviewed retrospectively. RESULTS: We identified three separate types of pancreatic tumors that had substantially different morphologic and prognostic features. Among these rare tumors, anaplastic carcinoma was the most common (nine of 14 cases), and these tumors were large, partly necrotic, locally invasive, and invariably metastatic (lymph nodes and/or liver) at the time of diagnosis. Three patients with poorly differentiated (small cell) carcinoma had a confluent pancreatic mass and lymphadenopathy but no ductal obstruction, closely resembling lymphoma or metastatic disease. Two patients with giant cell (osteoclastlike) carcinoma had a large, encapsulated multicystic tumor with hemorrhage, and these tumors were resectable for cure. CONCLUSION: Although a specific diagnosis may not be possible in some cases, we believe that knowledge of certain pathologic and computed tomographic features should lead to optimal diagnosis, therapy, and prognosis.     

Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center

Objectives: Incidental findings found on computed tomography (CT) scan during the Emergency Department evaluation of trauma patients are often benign, but their presence must always be communicated to patients, who should be referred for follow-up care. Our objective was to quantify the frequency of these incidental CT findings in trauma patients. A secondary goal was to determine how often these lesions were communicated to patients and how often patients were referred for follow-up. Methods: We performed a retrospective chart review of 500 consecutive patients presenting as trauma activations. Subjects received head, chest, or abdomen/pelvis CT scans at our hospital. Patients were identified using our trauma registry. Final CT reports were examined and discharge summaries were reviewed for basic demographics. Scans with incidental findings prompted detailed secondary review of discharge summaries to determine follow-up. Investigators reviewed incidental findings and classified them into three groups by clinical importance, using predetermined criteria. Results: Of the 500 patient charts identified for review, 480 (96%) were available, yielding 1930 CT reports for analysis. Incidental findings were noted in 211 of 480 (43%) patients and on 285 (15%) of the 1930 CT studies performed for the 480 patients. Of available patient records, only 27% of patient charts had mention of the finding in the discharge summary, had documentation of an in-hospital workup, or had documentation of a referral for follow-up. Most-concerning lesions, such as suspected malignancies or aortic aneurysms, accounted for 15% of all incidental findings and were referred for follow-up in only 49% of cases. Conclusions: Incidental findings were noted in 15% of trauma CT scans. Follow-up was poor, even for potentially serious findings. Further studies should examine the long-term outcome of patients with these findings.     

RENAL DISEASE ASSOCIATED WITH ANTINEUTROPHIL CYTOPLASMIC ANTIBODY: 39 PATIENTS OVER A 5-YEAR PERIOD

SUMMARY We have reviewed 39 adult patients who presented over a 5-year period with biopsy confirmed renal disease in association with positive antineutrophil cytoplasmic antibody (18 with C-ANCA, 21 with P-ANCA). Twenty-three (59%) had primary systemic vasculitis, typically with aggressive renal histology including focal necrotising and crescentic glomerulonephritis. In the remaining patients a wide range of clinical syndromes and renal histological appearances were apparent: 30 had abnormal renal function (serum creatinine >140 μmol/l), including 17 who were initially dialysis-dependent. Intensive immunosuppression was administered in 33 cases. When response was assessed at 3 months, renal function was stable or improved in 17 (52%), 5 of whom were able to discontinue dialysis. There was, however, an appreciable early mortality and, at latest follow-up (1–57 months), 12 patients had died and 8 were on the dialysis programme. On immunosuppression, ANCA became negative in the majority (median time 1.5 months) but recurred during clinical relapse in 11 cases. In asymptomatic patients (12 cases), the reappearance of ANCA positivity did not herald clinical relapse. The ANCA assay has increased awareness of systemic vasculitis but not removed the need for histological confirmation before instituting immunosuppression.