干细胞移植与再生障碍性贫血治疗

近30年来应用干细胞移植治疗重症再生障碍性贫血已取得了显著的临床进展,使再生障碍性贫血有了治愈的可能性.随着对患者预处理方案的逐渐改善,干细胞移植并发症的发生率及严重性均得到很好的控制.文章通过检索Pubmed数据库相关文献,了解干细胞移植治疗再生障碍性贫血的最新进展,揭示和探讨了干细胞移植预处理方案的改进对移植失败率的控制效果.     

Thymoma, hypogammaglobulinemia, and pernicious anemia

We have described a patient with thymoma, hypogammaglobulinemia, pernicious anemia, and malignant schwannoma. Review of the literature yielded only one other case of the triad of thymoma, hypogammaglobulinemia, and pernicious anemia. We propose that autoimmunity was the common etiology for the coexistence of thymoma, hypogammaglobulinemia, and pernicious anemia in our patient.     

骨髓小粒在再生障碍性贫血和低增生骨髓增生异常综合征诊断和鉴别诊断中的意义

目的探讨骨髓小粒在再生障碍性贫血(AA)和低增生骨髓增生异常综合征(MDS)的诊断和鉴别诊断中的意义。方法对已明确诊断的30例AA和6例低增生MDS的骨髓小粒进行回顾性分析。结果 AA组的骨髓小粒中非造血细胞比率显著高于低增生MDS组(P<0.01),后者的原粒+早幼粒细胞比率高于前者(P<0.05),并有病态造血。结论骨髓小粒分析对AA和低增生MDS的诊断与鉴别诊断有重要的参考价值。     

Thymoma

<正>Thymoma is a tumor of thymic epithelial origin,and it is a common cause of anterior mediastinal mass in adults.Occasionally,these lesions arise in the middle or posterior mediastinum.It is extremely difficult to determine if thymomas are benign or malignant by histologic criteria.Local invasion at surgery is a much more reliable sign,and the terms invasive thymoma or noninvasive thymoma are preferable to malignant or benign thymoma,respec-     

Thymoma

Thymomas, with their diverse signs, symptoms and relationships to other systemic diseases, are not infrequently encountered. Histologic classification is now standardized. Thymoma is associated with other disorders, such as myasthenia gravis and pure red cell aplasia. Proper staging, careful histologic evaluation and appropriately selected therapy are necessary to ensure long-term survival.     

Thymoma

Thymoma is a rare epithelial tumor of the thymus, but the most common malignancy in the anterior mediastinum. A unique feature is its association with paraneoplastic syndromes, in particular myasthenia gravis. According to the WHO classification 6 histologic types of thymic epithelial tumors can be discriminated. Tumor stage according to MASAOKA is the most important prognostic factor. Non-invasive tumors (stage I) are usually completely resected and no further therapy is warranted. For incompletely resected tumors and locally advanced invasive thymomas (stage Ill-IV) postoperative radiotherapy with 50-60 Gy is advisable. Chemotherapy, preferably with Cisplatinum, is indicated with inoperable thymomas or metastatic disease. In general thymomas have a fair prognosis even in advanced stage. Long term follow-up is mandatory up to 10 years.     

胸腺瘤的CT表现

目的 了解胸腺瘤的胸部CT表现以指导临床诊断与治疗。方法 87例经手术和病理证实的胸腺瘤患者的资料行回顾性分析。结果 CT检查能明确胸腺瘤的大小、部位、形态、范围、有无局部外侵,与周围组织的关系,包括气管、支气管、血管、胸膜以及淋巴结的转移。结论 CT检查能指导胸腺瘤的诊断,在估计胸腺瘤能否手术切除方面有重要作用。为治疗设计适宜的方案。     

胸腺瘤的CT诊断

目的：探讨胸腺瘤的ＣＴ诊断价值。资料和方法：胸腺瘤１７例，均经手术病理证实，其中６例仅作平扫，１１例平扫加增强扫描。结果：非侵袭性胸腺瘤７例，侵袭性胸腺瘤１０例，ＣＴ对两者的鉴别主要根据肿瘤的大小、边缘，肿瘤与心脏大血管的接触面、两者所成角度及其间的脂肪影，以及胸膜和心包改变。结论：ＣＴ对判断胸腺瘤是否为侵袭性有重要作用，为临床制定治疗计划，估计预后提供重要依据。     

Glomerulonephritis, Thymoma and Myasthenia Gravis

Three patients with myasthenia gravis, in whom a thymoma hadbeen removed during total thymectomy four to 14 years earlier,developed glomerulonephritis presenting as the nephrotic syndrome.AD had been treated previously by plasma exchange and were receivingazathioprine. Two were also taking prednisolone. Serum immunecomplexes containing IgM were present in all three. Renal histologyshowed either focal segmental glomerulosclerosis, minimal changelesion or focal proliferative glomerulonephritis. No immunoglobulindeposits were seen. Two patients lost their proteinuria on highdose corticosteroid therapy and their renal function improved.Glomerulonephritis occurred in nine per cent of patients withthymoma receiving immunosuppressive treatment with azathioprinefor more than two years. We suggest that this treatment maybe implicated in its aetiology.     

良、恶性胸腺瘤的CT诊断

目的:本文通过对良、恶性胸腺瘤的CT特征分析,试图提高对二者CT鉴别诊断的准确性。材料和方法:回顾性地分析经手术病理证实的胸腺瘤,其中良性14例,恶性19例。结果:良性胸腺瘤(14例)平均直径4.5cm,呈类圆形。除2例有点状钙化外,密度均匀,包膜完整,与周围大血管呈锐角。恶性胸腺瘤(19例)平均直径7.0cm,仅6例呈类圆型,9例分叶状,4例呈不规则浸润生长;6例包膜完整,9例不完整,4例无包膜;密度均匀14例,5例不均匀;9例与周围大血管呈锐角,5例呈钝角,5例包绕大血管。结论:CT诊断恶性胸腺瘤的可信性相当高,本文达100％,而良性胸腺瘤的相对较低,本文为77％。     

胸腺瘤的影像学诊断

目的：探讨胸腺瘤的影像学特征。方法：报告经手术与病理证实的胸腺瘤72例,其中包括良性胸腺瘤32例,恶性胸腺瘤27例和胸腺癌13例,全部病例均有X线平片,其中做CT检查37例,MRI检查7例。结果：病变发生在前上纵隔占87．4％,肿瘤呈圆形或椭圆形占68％,多球状4．2％,余为不规则形,肿瘤边缘呈小波浪状或结节状突起占77．6％,肿瘤与心脏大血管接触面（M－CI）呈灌铸型占48．6％。结论：CT与MRI能清楚地显示胸腺瘤的各种病理改变,具有特征性表现,为其临床诊断提供可靠依据。     

骨桥蛋白在胸腺瘤组织中的表达及临床病理意义

目的检测骨桥蛋白（osteopontin,OPN）在胸腺瘤组织中的表达情况并探讨其临床病理意义。方法应用免疫组织化学SP法检测OPN在60例胸腺瘤和18例正常胸腺组织中的表达情况,结合病例资料及胸腺瘤Masaoka分期、胸腺瘤WHO分型,比较OPN在胸腺瘤与正常胸腺组织、不同胸腺瘤Masaoka分期、不同胸腺瘤WHO分型的表达差异。结果OPN在胸腺瘤组织中阳性颗粒的平均灰度和阳性单位值显著高于正常胸腺组织（P〈0．05）;OPN在胸腺瘤不同Masaoka分期间阳性颗粒的平均灰度和阳性单位值差异均有统计学意义（均P〈0．01）;OPN在胸腺瘤不同WHO分型间阳性颗粒的平均灰度和阳性单位值差异均有统计学意义（均P〈O．01）。结论OPN与胸腺瘤的形成及胸腺瘤的恶性程度、侵袭性有关。OPN的表达可能作为胸腺瘤临床诊断和患者预后判断的一个重要参考指标。     

肺内胸腺瘤一例报告

病例女，45岁，左胸间歇性刺痛伴咳嗽、气急2周入院，无四肢乏力和消瘦。入院体检：精神萎糜，检查合作；面色苍白，巩膜无黄染，皮肤无瘀点、瘀斑；左胸下部叩诊呈浊音，左肺呼吸音低，心律齐；腹软，肝脾未及；四肢肌力正常，无病理性神经反射。实验室检查：Hb在１周内由119g/L降至28.4g/L；肝、肾功能及其他各项生化指标均正常。辅助检查：头颅CT未见异常；胸部平片和CT示左下肺肿块，大小（6.5×6.5×6.0）cm3，边界清楚，伴左侧胸腔积液增多，诊断为肺癌（图１）；骨扫描未见异常；B超示腹腔未见异常，但左胸有少至中等量积液；纤…     

胸腺瘤合并重症肌无力病人的麻醉

目的：分析胸腺瘤合并重症肌无力病人的麻醉管理。方法：对28例胸腺瘤合并重症肌无力病人麻醉进行回顾性分析，讨论该种病人的麻醉管理。结果：28例病人麻醉过程相对平稳，25例病人术后短时间拔管，麻醉后复苏室观察1～3h后送外科监护室观察1～3d，3例病人带管直接送外科监护室，24h之内拔除了气管导管。无一例重症肌无力危象发生。结论：胸腺瘤合并重症肌无力病人需要术前认真准备，术中仔细操作避免大出血，应用平衡麻醉，术后加强监测能够有效防止重症肌无力危象的发生。     

硬化性胸腺瘤1例报告并文献复习

目的：探讨硬化性胸腺瘤的诊治特点。方法：对硬化性胸腺瘤1例进行文献复习。结果：1例罕见硬化性胸腺瘤,术前诊断为前纵隔占位（考虑畸胎瘤）,经胸骨正中切口完整切除并明确诊断。结论：硬化性胸腺瘤属于罕见疾病,易漏诊,术前影像学诊断并无特殊。其病理组织学特点为肿瘤内含上皮细胞和淋巴细胞而表现为经典胸腺瘤的特征,但广泛的透明样变和硬化的纤维胶原包裹肿瘤组织。     

螺旋CT对侵袭性胸腺瘤与非侵袭性胸腺瘤的鉴别诊断价值

目的　用螺旋CT(spiralCT ,SCT)扫描评价胸腺瘤侵袭与否的临床价值。方法　收集了经病理证实的胸腺瘤共2 5例 ,其中侵袭性胸腺瘤 (invasivethymoma ,IT) 11例 ,包括 2例胸腺癌 ;非侵袭性胸腺瘤 (noninvasivethymoma ,NIT) 14例 ,通过分析胸腺瘤的各种表现和强化形式以及与纵隔结构的关系判断其侵袭与否 ,并与外科手术对照。结果　①IT大多表现为分叶状或不规则轮廓 (9/ 11,占 81.8% ) ,强化不均匀中心低密度 (8/ 11,占 72 .7% ) ,对纵隔结构侵犯 (11/ 11,占10 0 % ) ,2例胸腺癌均表现为肺内转移 ;②NIT表现为类圆形 ,有完整的包膜 (14 / 14 ,占 10 0 % ) ,肿瘤强化大多呈均匀一致(12 / 14 ,占 85 .7% ) ,对纵隔结构均无侵犯。结论　螺旋CT对胸腺瘤侵袭性与非侵袭性的诊断有较高的准确性。