125Ⅰ粒子置入辅助治疗原发性肝癌肝外转移的疗效评价

半年内每1个月复查1次,包括胸、腹部或病变部位CT,X线胸片检查;半年后电话追踪随访患者生存状况,每3个月随访1次,直至失访,评价患者近期平均生存期.结果 肝外病变完全缓解16例,部分缓解3例,稳定4例,进展3例.肝脏病灶完全缓解11例,部分缓解4例,稳定6例,进展5例.26例患者随访期内均存活,随访时间7.0～24.0个月,中位生存期14.5个月.结论 125Ⅰ粒子置入辅助治疗原发性肝癌合并肝外转移灶,可明显改善患者生活质量,有助于延长生存时间,是一种有效的辅助治疗手段.     

肾移植术后并发恶性肿瘤分析

目的 了解恶性肿瘤在肾移植患者中的发病率,并探讨其发病率增高的机制.方法 回顾性分析1998～2005年接受免疫抑制治疗的829例肾移植患者中15例发生恶性肿瘤的病例.恶性肿瘤总发病率为1.9%,其中泌尿系统肿瘤占66.7%,肝癌占13.3%,淋巴瘤、皮肤癌及肺癌各占6.7%.结果 15例患者肾移植术后肿瘤诊断时间为20～73个月,平均时间54.7个月.诊断肿瘤时14例患者肾功能正常,1例患者肾功能失功能.发现肿瘤时均无远处转移,3例肾盂尿路上皮癌患者肿瘤侵犯输尿管腔.肿瘤治疗以手术治疗为主,并及时调整减少免疫抑制药物剂量,辅以化疗和放疗、免疫治疗.结论 肾移植患者发生恶性肿瘤除了与应用免疫抑制治疗有关,也不能忽视移植术本身及肾移植术前原发病带来的影响.     

大剂量甲孕酮治疗晚期耐药乳腺癌的效果评价

1 临床资料 25例晚期乳腺癌患者,年龄48(35～70)岁.转移部位:骨转移17例,肺转移8例,胸壁软组织7例,胸腔积液5例,肝转移5例,骨髓转移3例,脑转移2例.     

89Sr治疗乳腺癌和前列腺癌多发性骨转移的临床观察

目的 探讨放射性核素89Sr治疗乳腺癌和前列腺癌多发性骨转移患者的临床效果.方法 回顾性分析30例乳腺癌和40例前列腺癌多发性骨转移患者接受89Sr治疗的病例资料,采用Karnofsky评分量表和骨显像方法进行疗效评估.结果 乳腺癌组的止痛总有效率为79%,前列腺癌组的止痛总有效率为85%,两组患者之间差异无统计学意义(x2=0.78,P＞0.05).两组患者的生存质量均有明显改善,治疗前后两组患者的Karnofsky评分均有明显提高(t=2.46,P＜0.05;t=2.68,P＜0.05).治疗后两组患者均未见明显骨髓抑制与肝肾功能损伤.结论 89Sr治疗乳腺癌和前列腺癌多发性骨转移止痛效果良好,患者生存质量有明显提高.     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.     

吉非替尼单药治疗晚期食管癌的初步观察

1 临床资料 1.1 一般资料 2004年10月19日-2008年1月8日南方医院肿瘤科收治的既往化疗失败的晚期食管癌患者23例,所有病例均经病理学确诊,并有可测量病灶,其中高分化鳞癌10例,中分化鳞癌5例,低分化鳞癌8例.患者血常规及心、肝、肾功能基本正常.23例患者中,男16例,女7例,年龄33～75岁,中位年龄53岁.所有患者均接受过含铂类方案或含氟尿嘧啶方案化疗.     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.     

肺癌、乳腺癌、食道癌远端骨转移特点的对比研究

目的 对比研究肺癌、乳腺癌、食道癌患者骨转移灶分布特点.方法　对肺癌、乳腺癌、食道癌患者454例进行 99Tcm-亚甲基二膦酸盐(99Tcm-MDP)SPECT全身骨显像,以上肢中远端和(或)骨盆、下肢部位发生骨转移为纳入条件,分析骨转移灶的分布特点及其在病种间的区别.结果 454例肿瘤患者中,上肢中远端和(或)骨盆、...     

胃混合性神经内分泌-非神经内分泌肿瘤CT表现及病理分析

目的:探讨胃混合性神经内分泌-非神经内分泌肿瘤(M iN EN)的C T特征及临床病理表现.方法:回顾性分析17例经病理证实的胃M iN EN患者的影像学及临床病理资料.所有患者术前均行CT平扫及增强扫描.结果:17例胃MiNEN患者的中位年龄为62岁,男女比例2.4:1;病灶位于贲门胃底12例,胃体2例,胃窦3例;1...     

Nd∶YAG激光治疗早期声门癌

目的探讨早期声门型喉癌激光治疗的方法.方法用Nd∶YAG激光配合喉显微手术对23例早期声门型喉癌患者进行癌肿切除治疗.结果 23例患者术后随访3年,仅1例因复发而行半喉切除术.其余患者均临床治愈且声音恢复满意.结论 Nd∶YAG激光治疗早期声门型喉癌是一种简便、有效的治疗方法.     

家庭多人同时烧伤的治疗与护理

目的:总结家庭多人烧伤的致伤机制、病例特点、创面治疗与护理经验,提高救治水平,加强防范措施。方法:对我科2000年1月-2004年12月收治的家庭多人(≥2人)同时烧伤病人(18起46例)的创面均采用湿润烧伤膏(MEBO)治疗,从病例特点、治疗护理经验等方面进行回顾性分析。结果:出现焦虑、烦躁等情绪病人的心理指标得到改善,浅Ⅱ度、深Ⅱ度及浅Ⅲ度创面均自行愈合,深Ⅲ度创面经MEBO治疗 4周行自体皮移植治疗,46例病人全部治愈。结论:家庭多人烧伤并不少见,病例特点与治疗方法类似于成批烧伤,创面采用湿润烧伤膏治疗效果满意,加强创面处理和注重心理治疗有助于病人康复。     

改进的定位技术在胸部肿瘤穿刺活检中的应用

目的：探索CT-SIM三维定位系统、体模固定技术和PET-CT融合影像导引定位技术在胸部肿瘤经皮穿刺活检中的应用价值。方法：对380例胸部肿瘤患者行改进的CT定位技术下的经皮穿刺活检术。根据肿瘤的大小、深度、毗邻关系、活动度以及患者的心肺功能状态,综合运用CT-SIM系统、体模固定技术和PET-CT融合影像导引技术,为患者进行穿刺前定位。统计穿刺定位时间长度、成功率、确诊率、并发症发生情况,并与210例采用传统铅栅定位下胸部肿瘤穿刺活检的相应资料进行比较。结果：采用改进的CT定位技术的380例患者穿刺定位精确,平均定位时间（9.5 min）较传统方法（16.8 min）缩短7.3 min,活检成功率和确诊率分别是98.7%和95.3%,高于传统定位方法的93.3%和83.3%,两者差异均具有统计学意义（P〈0.05）。穿刺并发症发生率相似,气胸发生率分别为2.8%和2.9%,咯血发生率分别为11%和12.8%。结论：根据患者状态及肿瘤特点,在CT-SIM系统快速精确定位技术的基础上,综合运用体模固定技术和PET-CT融合影像导引技术,能显著缩短经皮穿刺活检的定位时间,提高活检成功率。     

Traumatismes de l'épaule chez les joueurs français de rugby de haut niveau

Aim of the study

Specify the frequency and the type of injuries of the shoulder arising during the practice of professional rugby in France. Outcomes were studied according to the treatments performed.

Materials and methods

It is a matter of a retrospective study on 154 players of high level. Any shoulder injury endured during the practice of rugby was registered. The age of the player, his experience, his position on the field, the type of injury, the game phase, the treatment and eventual residual disability were specified.

Results

Ninety-eight players (64%) reported at least one injury of the shoulder. Thirty (19%) reported at least two injuries on the same shoulder. The acromio-clavicular joint injuries were the most frequent (49%). The treatment was medical in most of the cases. A rest of 17 days in average was noted. All the players came back to their better level. Instability of the gleno-humeral joint was retrieved by 15% of the players. A secondary treatment by surgical stabilization was noted in more than half of the cases. The rest was in average of one week after the injury. It was in average of 4 months after surgery. A significant persistent discomfort was retrieved by 43% of the non operated cases and by 27% of the operated cases.Different other injuries were noted: 17 clavicular fractures, 6 sterno-clavicular sprains, 5 rotator cuff injuries and 4 muscular contusions.

Discussion

Injuries of the shoulder are frequent among high level rugby players and represent an important source of morbidity. Injuries of the acromio-clavicular joint are the most frequent. The medical treatment allows a quick return to sport without level loss in mostly cases. Gleno-humeral instability represents the second traumatism in terms of frequency. A secondary treatment by surgical stabilization is preferable.     

光斑尺寸对单粒子倍性检测结果的影响

目的：探讨基于单粒子倍性检测技术中光斑与细胞的相对大小对细胞倍性分析结果的影响，确定合适的入射场光斑范围。方法首先，对影响单粒子细胞倍性检测结果的主要因素光斑厚度进行理论分析；然后借助ZEMAX进行光束整形系统设计，通过仿真以优化整形系统的参数；最后根据细胞粒径，确立目标光斑尺寸，搭建光学检测平台，获取一组厚度不同的光斑，分别进行细胞倍性检测。结果仿真和光学平台均获得了目标光斑，细胞倍性实验中，光斑厚度同时大于单核、双联体细胞时，平均荧光强度比值为2．03，符合倍性指标要求。结论以电压脉冲信号峰高表征荧光强度时，光斑与细胞的相对大小会影响倍性检测的准确性，光斑厚度必须同时大于单倍体与多倍体细胞，才能得到真实的倍性关系。     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Posterolateral complex knee injuries: magnetic resonance imaging with surgical correlation

Purpose: To describe the magnetic resonance imaging (MRI) findings of injuries of the posterolateral aspect of the knee and to evaluate the diagnostic capabilities of MRI in the assessment of these injuries.

Material and Methods: The MRI studies of 14 patients (mean age 33 years) with trauma to the posterolateral aspect of the knee were retrospectively reviewed, and the imaging findings were correlated with those of surgery.

Results: In all patients, MRI showed an intact iliotibial (ITB) band. MRI showed injury to the biceps tendon in 11 (79%), the gastrocnemius tendon in 1 (7%), the popliteus tendon in 5 (36%), and the lateral collateral ligament (LCL) in 14 (100%) patients. Tear of the anterior cruciate ligament (ACL) was seen in 11 (79%) patients and tear of the posterior cruciate ligament (PCL) in 4 (29%) patients. With routine MRI, visualization of the popliteofibular or fabellofibular ligaments was incomplete. On MRI, the lateral meniscus and the medial meniscus were torn with equal frequency (n = 4; 29%). Osteochondral defects were seen in 5 (36%) cases and joint effusion in all 14 (100%) cases on MRI. Using surgical findings as the standard for diagnosis, MRI proved 86% accurate in the detection of injury to the ITB band, the biceps tendon (93%),, the gastrocnemius tendon (100%), the popliteus tendon (86%), the LCL (100%), the ACL (79%), the PCL (86%), the lateral meniscus (90%), the medial meniscus (82%), and the osteochondral structures (79%). Surgical correlation confirmed the MRI findings of joint effusion in all cases.

Conclusion: MRI is well suited for demonstrating the presence and extent of injuries of the major structures of the posterolateral complex of the knee, allowing characterization of the severity of injury.     

A unique trend of murder-suicide in the Jamnagar region of Gujarat, India (a retrospective study of 5 years)

Jamnagar region, Gujarat state, enjoys a relatively low incidence of homicide in India. In the 5 year period from 2000 to 2004, 8 mothers committed 13 murders involving 3 male and 10 female victims and in every case it was followed by suicide of the assailant mothers. During the study the annual incidence of murder–suicide was about 1.8 cases. All the assailants were mothers and the victims were their small children in the age group of 6 months to 7 years. Five incidents took place in rural areas and three in urban areas. It was prevalent only in low socio-economic families. Methods both for killing and suicide were either burning or drowning. All the mothers were legally married and living with the family. Family and family related matters were the main motives for killing. In one case there was history of depression of the mother due to her previous miscarriage. Alcohol consumption or drug abuse was not seen even in a single case. All cases fell in the altruistic category of filicide–suicide.     

Management of fetal mediastinal shift: a practical approach

The purpose of this article is to review the technique of fetal chest ultrasound screening evaluation, the diagnostic work-up in the presence of fetal mediastinal shift and which ultrasound imaging features to look for. The first step in evaluating the fetal thorax is to confirm situs. Then, a median sagittal line is drawn from a four-chamber view to assist in spatial orientation followed by echotexture analysis of the structures of the thorax in the presence of mediastinal shift. We propose a systematic approach based on the direction of the mediastinal shift and echogenicity of the compressing hemithorax. When the hemithorax contralateral to the mediastinal shift is enlarged, which is the most frequent situation, diaphragmatic hernia and macrocystic congenital cystic adenomatoid malformation are the most likely etiologies when the mass is heterogeneous. Microcystic congenital cystic adenomatoid malformation, sometimes associated with sequestration, is the most frequent etiology when the mass is homogeneous. When the hemithorax ipsilateral to the mediastinal shift is small, which is less frequent, and the contralateral hemithorax is homogeneously isoechoic, then a diagnosis of lung hypoplasia-agenesis-aplasia should be considered.