泌尿生殖系恶性肿瘤与多原发癌

本文服告有关泌尿生殖系恶性肿瘤与多原发癌(MPC)例,其中男8例,女1例,年龄17～75岁),平均年龄47.1岁,均经病检确诊。由于人类寿命的延长,MPC有增多趋势,其危险性亦渐增加。对泌尿生殖系恶性肿瘤患者,要注意第二、三原发癌的发生。作者结合文献复习,对MPC的病因、发生率、生长特点、临床意义、治疗及预后作了简要的讨论。     

原发性卵巢平滑肌肉瘤及纤维肉瘤临床病理分析

目的:探讨原发性卵巢肉瘤的临床特点、诊断、治疗及预后。方法:分析我院2例原发性卵巢肉瘤患者的病例资料,并复习相关文献。结果:本组2例原发性卵巢肉瘤患者均未能早期确诊,病情发展快,手术难度大,预后差(1例已死亡)。结论:原发性卵巢肉瘤的早期诊断困难,主要依靠病理,核分裂像多见,病理性核分裂像可见,免疫组化显示Vimentin( )。该病恶性程度高,治疗效果及预后均差,可辅助化疗及放疗。     

胰腺实性假乳头状瘤19例的临床诊治分析

目的探讨胰腺实性假乳头状瘤（SPTP）的诊断和治疗。方法对安徽省立医院2000年1月-2010年1月经术后病理证实的19例SPTP的临床资料进行回顾性分析。结果首诊临床表现以腹部肿块、腹痛、腹胀多见。影像学检查均提示胰腺或腹腔内边界清楚的实性或囊实性占位病变。手术方式包括肿瘤局部切除术8例、肿瘤扩大切除术5例、胰腺节段切除术2例、胰体尾联合脾脏切除术3例,1例因侵及门静脉无法切除仅行活检术。16例术后恢复顺利,2例并发胰漏,经引流后治愈。结论 SPTP是一种低度恶性肿瘤,完整的肿瘤切除治疗能够获得良好预后。手术术式的选择应依据术前CT等影像检查和术中探查判断。     

鼻腔血管外被细胞瘤的临床病理(附三例报告并文献复习)

本文报告三例原发于鼻腔的血管外被细胞瘤,结合复习文献中的26例,对血管外被细胞瘤的发病率、发生部位、临床表现及生物学行为、良、恶性血管外被细胞瘤的鉴别诊断,以及治疗及预后等问题进行了讨论。作者认为可将此瘤分为三种类型:(1)组织学为良性者(属低度恶性)。(2)组织学为交界性者(属中度恶性)。(3)组织学为恶性者(属高度恶性)。     

How valuable is ascitic cytology in the detection and management of malignancy?

Introduction: Ascitic cytology is often requested in the early stages of ascitic assessment. A review of this practice in a major English teaching hospital is presented. Method: Patients were retrospectively identified using the histopathology and patient administration system between January 1999 and May 2001. Results: Of 276 samples sent for assessment 35 cases were found to be negative when on further review an intra-abdominal malignancy was present. The malignancy was diagnosed using a radiological modality. The sensitivity of ascitic cytology was found to be 60% with 100% specificity. A delay of up to five days could be incurred awaiting the cytology results before further radiological examinations were undertaken. Conclusion: Too much hope is placed on ascitic cytology to provide the diagnosis at the expense of other investigations. It is recommended that the initial assessment should concentrate on history, examination, and basic tests on ascitic fluid to assess the serum-ascites albumin gradient. Ovarian malignancy is the only tumour type yielding a significant rate of detection from cytology with some prognostic impact. Results should not be awaited before abdominal ultrasound is undertaken. This more directed practice would help reduce unnecessary workload for the pathologist and has resource implications.     

When Fryn met Edward: Two rare syndromes in a single patient

A neonate born at our centre was diagnosed as Fryns Syndrome ie congenital diaphragmatic hernia with facial dysmorphism and distal limb anomalies, which is a rare disorder with only a few hundred cases reported till date.With high clinical index of suspicion and further evaluation, the diagnosis was confirmed. The baby was initially stabilized and later underwent repair of the diaphragmatic hernia. Despite best measures, the baby could not be salvaged. When severe, this can be lethal and diagnosis can only be made after autopsy. However, with early suspicion, better modalities of investigations available and improved NICU care, these babies can be salvaged. We report a case of Fryns Syndrome who was incidentally found to have Edward Syndrome as well. Such an extremely rare combination is yet to be reported in medical literature.Also with updated genetic studies, better diagnostics and treatment options coming up in future, there are chances to improve the survivability of these babies. It is prudent to document all such cases to aid in better understanding of the disease process.     

恶性纵隔肿瘤的诊断及外科治疗

目的 探讨恶性纵隔肿瘤的临床特点、诊治方法。方法 回顾分析我院1976年1月～2003年7月收治并经病理证实的57例恶性纵隔肿瘤。结果 恶性胸腺瘤26例、恶性畸胎瘤11例、恶性神经源性肿瘤4例，恶性脂肪病2例、纵隔类癌2例等；除无手术指征的5例使用放、化疗外，手术切除52例，其中根治性切除44例，姑息性切除5例，探查3例，手术切除率94．2％（49／52)，术后随诊1个月～25年，1、3和5年生存率分别为：72．2％、50．13％和30．5％。结论 本病诊断主要依靠临床症状和X线、CT检查；治疗应以手术为首选，姑息切除术后配合放疗可提高疗效。     

3例骨内原发造血细胞假瘤的诊断及9年随访

本研究收集、分析3例骨内造血细胞假瘤的临床病理资料，初始临床和病理学诊断，都被误诊为恶性肿瘤/转移灶，其中2例 分别随访了132月和100月，均证明为良性肿瘤（1例失访）。造血细胞假瘤由类似正常造血组织组成的骨内罕见的良性病变，易 被误诊为恶性造血细胞肿瘤，熟知其临床病理特征与转归过程，能够建立正确的个体化诊治方案。     

原发性小肠恶性肿瘤103例临床分析

目的探讨原发性小肠恶性肿瘤的临床特点及其诊断方法。方法回顾分析1996～2004年我院诊治的103例原发性小肠恶性肿瘤的临床资料、病理特征及术前诊断方法。结果103例中,肿瘤位于十二脂肠者81例,空肠14例,回肠8例。术前确诊42例,误诊61例,误诊率为59.2%。最常见的临床表现为腹痛、消化道出血、黄疸、腹块、肠梗阻等。首选的检查方法为低张小肠气钡双重造影,内镜检查可提高十二指肠恶性肿瘤的诊断率,对诊断困难的消化道出血可行选择性腹腔动脉数字减影血管造影,CT对判断肿瘤的性质、术前分期及术后有无复发有意义。结论原发性小肠恶性肿瘤临床表现不典型,早期诊断极为困难,误诊率高,低张小肠造影是诊断和定位的有效的方法。     

Diagnostic work-up in peripheral neuropathy: an analysis of 171 cases

This study was set up to evaluate retrospectively the efficacy of a standard diagnostic procedure, including non-invasive and invasive (spinal tap, nerve/muscle biopsy) investigations, in the diagnosis of peripheral neuropathy. The medical records of 171 in-patients with the final diagnosis of peripheral neuropathy of determined or undetermined cause were reviewed and each individual diagnostic work-up was analysed. Basic investigations included the patient's history, a clinical examination and basic laboratory tests. Depending on the individual presentation, course, and severity, further non-invasive and invasive examinations were added according to the department's standard diagnostic procedure. The aetiology could be clarified in 124 patients (73%) and remained unclear in 47 cases. Excluding cases with acute and chronic inflammatory polyneuropathy (n=14), the number of idiopathic peripheral neuropathies dropped to 33. Non-invasive investigations were sufficient to reveal the underlying aetiology in 114 cases (83 %). It is concluded that, with the application of a standard procedure for the diagnosis of peripheral neuropathy, the aetiology can be clarified in 81% of patients. In the other 19% of patients the aetiology remains idiopathic. In the majority of cases, non-invasive investigations were sufficient for diagnosis.     

Bruises, blood coagulation tests and the battered child syndrome

Cutaneous bruises are a common symptom and a sign of injury and blood coagulation disorders in childhood. A carefully-taken history, coupled with a thorough physical examination, would lead to the diagnosis, or guide the clinician to the necessary laboratory investigations. Most children suffering from non-accidental injury can have their diagnosis established on clinical grounds alone and do not require laboratory investigation. An initial screening with full blood counts, prothrombin time and activated partial thromboplastin time will be adequate in most cases if laboratory investigation is indicated, but the clinician must be aware of the limitations of these tests. The finding of an abnormal coagulation test does not exclude child abuse as it can be a consequence of maltreatment, or the two conditions may coexist. Whenever necessary, the opinion of a haematologist should be sought in order to obtain an accurate diagnosis, which is essential for subsequent management and the prevention of further injury in the case of child abuse.     

18例原发性颈静脉扩张症的诊断和治疗

目的探讨原发性颈静脉扩张症的诊断和治疗,提高对本疾病的认识.方法回顾我科1980～2002年收治的18例原发性颈静脉扩张症病例,分析其临床表现和诊断,12例采用手术治疗,方法均为扩张静脉近远中端结扎后切除.结果18例病例临床诊断明确,12例术后随访2～9年,效果满意.结论根据临床特征和影像学检查可以明确诊断,对有症状者主张手术治疗.     

GREY SCALE ULTRASONOGRAPHY IN DIAGNOSIS OF PELVIC MASS AND EARLY OVARIAN CARCINOMA

This article analyzes 157 cases of adnexal tumors found among 300 cases of pelvic masses studied by Grey scale ultrasonography in order to study the efficacy of this mode of examina- tion in differential diagnosis of beinign and malignant tumors, particularly its value in diagnosing early ovarian malignancy. The correct diagnoses in benign and malignant lesions are 92.4To and 92.1To. In diagnosis of clinical Stage l and 2 0varian malignancy, accuracy is 8W70. Ultrasound is safe, sensitive, harmless. and can be used to follow internal structure changes, so it is an available method of diagnosing ovarian malignancy early.     

原发性先天性胆管囊肿癌变7例的诊断与治疗

目的：总结20年来7例在发性胆管囊肿癌变的诊断及治疗经验。方法：对1980－2000年间收治的7例原发性胆管囊肿癌变病人的临床资料进行回顾性分析。结果与结论 癌变6例位于囊壁,1例侵及胰腺,术后病理结果为腺癌。对先天性胆管囊肿病人推荐行新的预防癌变的手术方式,术中冰冻切片检查有助于确诊,对侵及胰腺的病例考试行囊肿切除及胰十二指肠切除术。     

原发性甲状腺鳞状细胞癌1例并文献复习

 观察1例原发性甲状腺鳞癌患者的诊治经过,结合文献分析原发性甲状腺鳞状细胞癌的临床特征和生存相关因素。早期诊断和早期治疗对于原发性甲状腺鳞癌患者的生存质量和生存时间具有决定性的作用。甲状腺良性肿瘤长期刺激也有可能导致细胞鳞状化生和癌变,早期手术并能完整切除肿瘤是最重要的决定预后的因素,放化疗可进一步延长患者的生命。临床工作重点是早期诊断甲状腺鳞癌,甲状腺良性肿瘤的随访和处理应该更积极,治疗上首选手术,可适当辅以放化疗。     

Delayed presentation of port-site metastasis from an unknown gastrointestinal malignancy following laparoscopic cholecystectomy

Port-site metastasis (PSM) is often encountered during laparoscopic surgery in patients with malignancy. We report a 45-year-old woman who presented with a single PSM from papillary adenocarcinoma after undergoing laparoscopic cholecystectomy for calculus cholecystitis. Post cholecystectomy, a diagnosis of chronic cholecystitis was confirmed on histopathology. The patient presented with a mass at the site of epigastric port 28 months after surgery. PSM was suspected on clinical examination, which was supported by findings on computed tomography and further confirmed by fine-needle aspiration cytology of the lump. The patient underwent surgical clearance of the mass, and histopathological examination proved the lesion to be papillary adenocarcinoma. The site of the primary tumour was not detected even after thorough examination. Based on the histopathology report following local surgical clearance, the patient was started on chemotherapy. This case is unusualbecause of the long delay prior to the presentation of PSM and the unknown primary malignancy.     

Ultrasonography of intratesticular lesions: its role in clinical management

Ultrasound is the primary imaging modality in the investigation of patients with symptoms related to the scrotum, and is pivotal to the diagnosis of suspected testicular malignancy. This retrospective study analysed the results of testicular ultrasound at a large teaching hospital over a five year period. We wished to examine the clinical consequences for patients in whom ultrasound findings were suspicious of testicular cancer, and the accuracy of the ultrasound diagnosis. Real time ultrasound examinations were performed, providing multiplanar imaging of the testis and para testicular tissues. Over a five year period 661 examinations were carried out. An intratesticular lesion was identified in 44 patients; nineteen of these patients were shown to have testicular malignancy following tissue diagnosis. When ultrasound was used to identify testicular malignancy in those patients with an intratesticular lesion, it had a sensitivity of 94.7% and a specificity of 59.1%. A tissue diagnosis was obtained in 93% of those patients thought likely to have a testicular malignancy on sonographic assessment, and in 40% of those in whom a diagnosis of malignancy was possible, but less likely. Our study shows that this modality can be used to aid the clinician in deciding which patients should undergo orchidectomy, invasive biopsy or clinical surveillance.     

非特异性腰痛的对因治疗

非特异性腰痛是长期困扰临床医师的难题,目前存在着诊断混乱、疗效差的状况。为了明确病因以及做到对因治疗,我院进行了长期的基础和临床研究,并做了大量的文献调研,在此基础上总结出了几类非特异性腰痛的病因诊断及对因治疗措施。(1)脊神经后支综合征:因脊神经后支主干受机械刺激所致,治疗方法有液氮冷冻脊神经后支等。(2)腰椎间盘源性腰痛:由于腰椎间盘变性所致,可行腰椎间盘切除。(3)小关节综合征:小关节本身病变引发腰痛的情况很少,多数是由于小关节脱位刺激了旁边的脊神经后支所致。治疗方法同脊神经后支综合征。(4)腰椎不稳:由椎间连接松弛所致,可行腰椎融合。(5)棘上棘间韧带损伤:因棘间韧带损伤所致,疗法有封闭加小针刀松解术等。(6)内脏源性腰痛:是盆腔疾患的牵涉性痛,治疗原发病是关键。此几类非特异性腰痛的病因诊断及对因治疗措施供同行参考、商榷。     

非特异性腰痛的对因治疗

非特异性腰痛是长期困扰临床医师的难题，目前存在着诊断混乱、疗效差的状况。为了明确病因以及做到对因治疗，我院进行了长期的基础和临床研究，并做了大量的文献调研，在此基础上总结出了几类非特异性腰痛的病因诊断及对因治疗措施。（1）脊神经后支综合征：因脊神经后支主干受机械刺激所致，治疗方法有液氮冷冻脊神经后支等。（2）腰椎间盘源性腰痛：由于腰椎间盘变性所致，可行腰椎间盘切除。（3）小关节综合征：小关节本身病变引发腰痛的情况很少，多数是由于小关节脱位刺激了旁边的脊神经支所致。治疗方法同脊神经后支综合征。（4）腰椎不稳：由椎间连接松驰所致，可行腰椎融合。（5）棘上棘间韧带损伤：因棘间韧带损伤所致，疗法有封闭加小针刀松解术等。（6）内脏源性腰痛：是盆腔疾患的牵涉性痛，治疗原发病是关键。此几类非特异性腰痛的病因诊断及对因治疗措施供同行参考、商榷。     

毛根鞘X染色质检查在妇科领域中应用

目的 探讨毛根鞘性染色质检查在原发性闭经及性发育异常诊治中的临床意义。方法 采用毛根鞘检出X染色质方法对原发性闭经及性发育异常患者进行筛查,配合核型分析作为病因诊断。结果 患病组186例中检出性染色质异常者73例(39．2％),其中染色体异常患者及XY个体36例(49．3％),所有XY个体均为性染色质阴性。结论 在原发性闭经及性发育异常人群中进行性染色质筛查,有助于病因诊断及XY个体检出。毛根鞘检出X染色质的方法具有操作简便、受检者无痛苦、不易受细菌污染的优点。但需配合染色体检查,才能明确诊断。