嗜酸性淋巴肉芽肿的临床特点和治疗

目的分析嗜酸性淋巴肉芽肿的临床病理特点,探讨合理的治疗方案。方法对20例经病理学确诊的嗜酸性淋巴肉芽肿患者的临床特点、治疗方法和预后进行回顾性分析。结果全组20例患者中男性多见,平均发病年龄39岁;临床上表现为单发或多发的结节性肿块,以腮腺区最为多见（41．4％）。所有患者外周血嗜酸性粒细胞均增高。病理学上表现为淋巴组织增生并形成淋巴滤泡,生发中心极性存在,血管周围及滤泡问大量的嗜酸性粒细胞浸润。行单纯手术治疗的3例患者中有2例复发。结论嗜酸性淋巴肉芽肿是一种具有特殊临床和病理表现的慢性炎症性疾病。单纯手术容易复发,手术联合放疗的综合治疗可提高疗效。     

Gender-related differences of risk factors among patients undergoing coronary artery bypass graft in Ahwaz, Iran

OBJECTIVE: To evaluate the major risk factors among male and female patients with severe coronary artery diseases undergoing coronary artery bypass graft (CABG). METHODS: This randomized clinical trial was performed on 897 (655 male and 242 female) patients from March 2001 to March 2006 in the Department of Cardiovascular Surgery, Golestan Hospital, Ahwaz, Iran, with male to female ratio approximately 2.7. The mean age was 54.37+/-0.3 years. The major risk factors were diabetes mellitus, smoking, hyperlipidemia, hypertension, obesity, familial history of coronary artery disease, past medical history of myocardial infarction and heart failure before surgery. RESULTS: The results show that the rate of risk factors among the males and females was age (male=54.01, female=55.35 years), smoking (p=0.00001), previous myocardial infarction (p=0.00004), heart failure (p=0.05), diabetes mellitus (p=0.0001), hyperlipidemia (p=0.00001), obesity (p=0.03), historical familial background (p=0.01) and hypertension (p=0.000001). The risk factors were revealed significantly higher in females than males (p<0.05). CONCLUSION: The incidence of the risk factors among the females showed higher than males patients.     

结核病专科医院24例诺卡菌病临床特征分析

目的 总结结核专科病院肺诺卡菌病临床特征,为早期识别该病提供依据。方法 收集并分析河北省胸科医院24例肺诺卡菌病患者临床表现、实验室检查、影像学、治疗和预后。结果 24例患者,男16例,女8例,发病年龄（58.1±9.8）岁;半数以上存在肺部基础疾病,其中曾患肺结核病治愈者4例,合并活动性肺结核1例,支气管扩张症18例,艾滋病1例。常见症状为咳嗽（24例）、咳痰（24例）、发热（14例）。胸部影像学表现为胸腔积液（2例）、斑片状影（17例）、胸膜增厚（13例）、纵膈淋巴结肿大（7例）、实变（8例）和空洞（5例）。肺诺卡菌病通过痰液、肺泡灌洗液、肺组织或脓肿穿刺物中发现诺卡菌后经分子生物学方法或质谱鉴定证实。21例患者应用包含复方新诺明的联合治疗方案,3例采用复方新诺明单药治疗,治疗有效21例,1例因多种药物过敏而治疗效果不佳,2例治疗后病情持续恶化自动出院而死亡。结论 结核病院肺诺卡菌病多见于结构性肺病,常规治疗无效的支气管扩张症患者要高度警惕肺诺卡菌病。     

探寻一家系短期3例胃癌的临床病理及其相关肿瘤特征

目的 总结家族聚集性胃癌(FGC)的临床特征,为其防治提供一定的参考价值。方法 回顾性收集2016年12月至2022年1月收治的同一家系兄弟姐妹3人先后患胃癌的临床资料,分析其一般情况、临床特点、治疗及转归,并随访至2022年3月。结果 胃癌在此家系中呈聚集性发病,其中男2例、女1例,发病时平均年龄47岁,3例患者具有共同的生活及饮食习惯,符合FGC的诊断,明确诊断后均接受手术及术后化疗,现1例患者已故,另外2例患者定期复查。结论 FGC的发病率较低,本文报道的短期内同一家系兄弟姐妹3人先后都患胃癌更为罕见,因此,家族中有超过2人患胃癌时,一定要注意预防FGC的发生。     

Globus hystericus--reports on 25 ENT cases and literature review

From October 1987 to March 1988, 25 cases (15 males and 10 females) with the globus hystericus were evaluated at 804 Army General Hospital. All patients underwent complete physical examination, routine laboratory work-up, roentgenographic examination of paranasal sinuses, cervical region and chest, upper G-I series, fiberoptic endoscopy and esophagoscopy. 2.3% of the patients in this study had the globus hystericus, the male to female ratio was 1.5:1, the mean ages were 51 years, the average educational level was low, the endoscopic findings were vallecular cyst in 3 cases (12%), epiglottic cyst in 2 cases (8%), the roentgenographic findings were maxillary sinusitis in 3 cases (12%), cervical osteophytes in 9 cases (36%) gastric ulcer, duodenal ulcer and diverticulum in 1 cases (4%) respectively. We analyzed the positive findings and reviewed the literature.     

伯基特淋巴瘤（附8例报告）

本文观察和分析８例伯基特淋巴瘤的临床与病理特征．其中男７例女１例．颈部４例，腹内２例，颅内和口腔内各１例．年龄最小３岁，最大５３岁，平均２０岁．病程７天～１年．主要表现是局部肿块，１例伴有福斯特一肯尼迪综合征．结合文献对本瘤的临床、病理和诊断进行了讨论．     

Prevalence of hypothyroidism and importance of cholesterol estimation in patients suffering from major depressive disorder

The coexistence of hypothroidism and depression is already reported and both of these conditions are known to share some common clinical symptoms. Serum cholesterol level is known to be altered in either condition considered separately. But, no report is obtained regarding serum cholesterol level when both the conditions coexist. In this study, 78 patients (61 females and 17 males, age ranged 19 to 67 years) suffering from major depressive disorder were included. Serum T3, T4, TSH and cholesterol levels were estimated in all of them. Sixty-two patients were found to be euthyroid and 16 patients (11 females, 5 males) were found to be hypothyroid. Among female patients, 6 had subclinical hypothyroidism and 5 had overt hypothyroidism. Among male patients 3 had subclinical hypothyroidism and 2 had overt hypothyroidism. The overall prevalence of hypothyroidism in major depressive disorder was estimated as 20.5%. Mean serum cholesterol level in 62 euthyroid patients was found to be 150.9% +/- 16 mg% and that of 16 hypothyroid patients to be 190.7 +/- 12 mg% showing a significant difference (p < 0.01). Thus estimation of cholesterol in major depressive disorder patients may give an idea regarding their thyroid status and vice-versa.     

Clinical profile of Ethiopian patients with breast cancer

This prospective study was designed to obtain information on demographic characteristics, clinical profile and problems related to early diagnosis and treatment of breast cancer in 72 Ethiopian patients. There were 62 females and 10 males, the female to male ratio being 6.2:1. The age range of the females was 21-82 (mean 41.8 +/- 12.8) years and that of the males' was 38-75 (mean 52.1 +/- 12.2) years. The time interval between the onset of breast-related symptoms to diagnosis varied from 2-108 (median 12) months. Infiltrating ductal and lobular carcinoma histologic types accounted for 85% and 11%, respectively, in 62 cases who had surgical biopsies. Surgery was performed in 46 cases out of whom only 21 cases received adjuvant treatment. Eighteen females refused mastectomy at some point before they came to our clinic with metastatic disease. After a median follow up duration of 36 (range 2-120) months, 29 cases were alive, 24 died and 19 were lost to follow up. The cause of death in 17 subjects (71%) was rapidly refilling pleural effusion and superimposed infection. Both females and males had similar clinical characteristics, except that, the males were older by 10 years. Moreover, the females in this series developed breast cancer at a younger age (72% were premenopausal) and 76% had advanced disease (Stages III and IV) at presentation, similar to females from other African countries. We suggest that the attitude of Ethiopian females towards breast cancer has to change through continuous but targeted public education.     

氩氦刀联合肿瘤病灶刮除植骨内固定术治疗胫骨近段骨巨细胞瘤疗效分析

目的 评价氩氦刀联合肿瘤病灶刮除植骨内固定术治疗胫骨近段骨巨细胞瘤对于术后膝关节功能 改善的影响。方法 选取2010 年1 月-2016 年12 月的23 例胫骨近段骨巨细胞瘤患者。其中,男性11 例,女12 例; 年龄16 ～ 39 岁,平均（25.8±9.1 岁）。依照不同治疗水平分为两组：单纯手术组11 例,男性5 例,女6 例; 年龄17 ～ 36 岁,平均26.5 岁;行肿瘤病灶刮除植骨内固定术。氩氦刀联合手术组12 例,男性6 例,女6 例; 年龄16 ～ 39 岁,平均28.1 岁;行氩氦刀联合肿瘤病灶刮除植骨内固定术。行标准化术后处理,记录各组并 发症情况,在第3、6 和12 个月采用美国特种外科医院（HSS）评分评价膝关节功能。结果 所有患者均获得 12 个月观察,两组患者间性别、年龄、体重、肿瘤Enneking 分级等一般资料差异无统计学意义（P >0.05）, 具有可比性。所有患者术后切口均一期愈合,单纯手术组术后下肢水肿1 例,小腿外侧皮神经损伤3 例,术后 第12 个月原位复发1 例。氩氦刀联合手术组术后1 例发生肺部感染,2 例发生小腿外侧皮神经损伤。不同时 间的HSS 膝关节功能评分有差异（F =91.264,P =0.000）;两组的术后HSS 膝关节功能评分有差异（F =41.411, P =0.000）,氩氦刀联合手术组术后HSS 膝关节功能评分较高,相对恢复效果较好;两组的HSS 膝关节功能评分 变化趋势有差异（F =4.972,P =0.037）。结论 氩氦刀联合肿瘤病灶刮除植骨内固定术治疗胫骨近段骨巨细胞 瘤肿瘤可改善术后第3、6 和12 个月的膝关节功能。     

儿童肾母细胞瘤个体化综合治疗的疗效分析

目的回顾性分析采用个体化方案对儿童肾母细胞瘤患者进行综合治疗的效果。方法收集2005年9月—2009年12月经临床、影像学和病理学检查确诊为肾母细胞瘤患者的临床资料。38例患者中男性24例,女性14例;平均年龄2.67岁;单侧病灶37例,双侧病灶1例。根据患者个体情况制定综合治疗方案。单侧肿瘤首选经腹行肿瘤和患肾切除术;对于手术风险较大的单侧肿瘤患者则先行CT定位下细针穿刺活检后实施术前化疗,使肿块缩小、转移灶消失后再行手术;根据肿瘤的组织学类型及临床分期选择制定术后化疗或化疗联合放疗方案。随访时间为12~60个月。结果总缓解率97.37%(37/38),总体生存率为89.47%(34/38),无瘤生存率86.84%(33/38);临床分期Ⅰ期和Ⅱ期患儿的无瘤生存率分别为100%(17/17)和91.67%(11/12),显著高于Ⅲ期和Ⅳ期患者的60.00%(3/5)和66.67%(2/3)(P<0.01);良好与不良组织学类型患者的总体生存率分别为96.77%(30/31)和57.14%(4/7),两者比较差异有统计学意义(P=0.001)。5例复发(占13.16%),其中3例为横纹肌肉瘤型。结论个体化综合...     

单中心16年青年膀胱尿路上皮癌患者的诊治

目的：研究40岁及以下青年膀胱尿路上皮癌患者的临床表现、临床分期、病理分级、治疗及预后等情况。方法：选择 2001年1月至2016年12月北京大学第三医院泌尿外科收治的43例40岁及以下的膀胱癌患者临床资料进行回顾性分析。结果：本组病例占同期科室收治的膀胱癌患者的2.2%,男性35例,女性8例,平均年龄33岁（23~40岁）。初诊时以无痛性肉眼血尿为主要症状者27例（62.8%）, 体检发现异常者9例（20.9%）,以膀胱刺激症状或排尿异常起病者7例（16.3%）。肿瘤单发者34例（79.1%）,多发者9例（20.9%）,且多发者均在31~40岁亚组。根据患者临床分期采用相应的手术方式治疗。 术后病理分级：低级别乳头状尿路上皮癌29例（67.4%）,高级别乳头状尿路上皮癌14例（32.6%）。Ta期31例（72.1%）,T1期7例（16.3%）, T3期1例（2.3%）, T4期3例（7.0%）,T1期合并Tis 1例（2.3%）。术后3例失访,另40例随访5~165个月,随访患者中有5例复发,复发率12.5%（5/40）, 平均复发时间39个月（3~105个月）, 2例患者进展,进展率5%（2/40）。多发患者组复发率33%（3/9）,单发患者组复发率5.9%（2/34）,两组差异具有统计学意义（P=0.000 3）。结论：青年膀胱癌的发病比例呈增长趋势, 无痛性肉眼血尿是青年膀胱癌的主要临床表现,但青年患者的下尿路刺激症状同样需警惕肿瘤的发生,术后的复发情况可能与多发病变有关。     

肺泡微结石症一例报告并文献复习

目的 了解肺泡微结石症（ PAM） 的临床特征。方法 复习国内发表的肺泡微结石症的病例, 结合近期我院收治的1 例肺泡微结石症病例进行分析。结果 85 例患者中, 男41 例, 女44例; 确诊时年龄7 ～69 岁, 平均（ 27 ±15） 岁; 其中35 例患者分属15 个家庭, 均为同胞兄弟姐妹, 8 个家庭父母为近亲婚配。多数患者无症状或症状轻微, 肺功能检查基本正常或为限制性通气功能障碍。典型的影像学表现为双肺弥漫的以中下肺野为主的高密度小结节, 73 例患者结合X 线表现和轻微的临床症状而确诊。无有效治疗方法。结论 肺泡微结石症是一种常染色体隐性遗传疾病, 临床症状和影像学表现分离高度提示本病。     

非骨化性纤维瘤的影像学诊断及鉴别诊断

目的 探讨非骨化性纤维瘤(NOF)的影像学特征,提高影像诊断水平。方法 回顾性分析经病理证实的NOF 20例,所有病例均做普通X线检查,17例做CT检查,7例做MRI检查。结果 发生于胫骨近端干骺端10例,胫骨远端干骺端5例,股骨远侧干骺端4例,桡骨远端干骺端1例,均为单发,病灶多沿患骨的长轴生长,多呈圆形或椭圆形,13例边缘有分叶,18例病灶边缘可见硬化边。结论 NOF影像学特点较典型,X线平片结合临床一般能正确诊断;而CT及MRI检查能更好地显示病变内部密度及信号特点,为诊断提供更为有力的证据。     

阿托伐他汀钙配合单孔双管冲洗引流治疗慢性硬膜下血肿疗效分析

目的 探讨阿托伐他汀钙配合单孔双管冲洗引流治疗慢性硬膜下血肿的临床疗效。方法 回顾分析2016年5月至2017年4月我院神经外科采用阿托伐他汀钙配合单孔双管冲洗引流治疗的42例慢性硬膜下血肿的临床预后及随访结果。男33例、女9例,年龄为38~82岁,平均年龄为（70.0±5.8）岁。42例患者均有头痛、头晕症状,36例有不同程度肢体肌力障碍。结果 42例患者中36例为单侧慢性硬膜下血肿,6例为双侧慢性硬膜下血肿。所有患者的头痛、头晕症状和肌力障碍术后24 h内均改善,1个月后症状完全消失。41例完全治愈,其中22例患者术后3个月时复查头颅计算机断层扫描（CT）提示血肿完全消失,19例患者术后6个月时复查头颅CT示血肿完全消失;1例（2.38%）双侧慢性硬膜下血肿患者因心房颤动口服华法林,术后1个月时复查头颅CT提示慢性硬膜下血肿复发,在随访过程中突发呼吸心跳骤停死亡。结论 阿托伐他汀钙配合单孔双管冲洗引流治疗慢性硬膜下血肿确实有效,值得推广应用。     

单肢骨骺发育异常

报告11例单肢骨骺发育异常,男8例,女3例,年龄15月～21岁。其中6例经手术和病理证实,另5例有典型的临床和X线表现。主要临床表现是关节附近的无痛性肿块和畸形。特征性的X线表现包括骨骺的过早出现和一侧或外半侧骺软骨的过度增生,多发骨化中心的形成,而后融合为一体,形成骨骺的偏侧性肥大。11例均仅累及单侧肢体骨骺,其中5例为多骨骺受侵。对有关本病的单质或异质性问题和误诊原因等进行了讨论。     

Diagnostic implications of genital Kaposi's sarcoma

Genital Kaposi's sarcoma (KS) before the AIDS epidemic was rarely seen in Uganda although a case was seen in 1973, 1982, 1983 and 1985. Eight cases were seen in 1986 and another 17 cases have been documented since the beginning of 1987. Of the 29 patients, 23 were males, 6 females (M:F = 3.8:1); median age 29 years (range 7-70 years). All except 8 males were under 40 years. Six patients had pure nodular disease, while the rest had mixed clinical type. The external genitalia was involved in nodular disease in 15 patients, 12 had infiltrative disease and 6 had ulcerative disease. Florid and plaque were seen in one case each. Mixed cellularity was typed in 13 patients. 19(70.4%) were positive for HIV serology (ELISA Wellcome kit) of whom 13(61.9%) were males. All females were positive. The patient who presented in 1973 remains alive and disease free 13.5 years making it unlikely that he had AIDS. It appears therefore that genital KS is a feature of HIV associated KS and this mode of presentation is new in Uganda.     

肺良性转移性平滑肌瘤的临床及影像学表现

目的 进一步提高对肺良性转移性平滑肌瘤(PBML)的临床及影像学表现的认识。方法 对国内21例PBML个例报道及本院1例PBML病例的临床及影像学表现进行总结及分析。结果 该组PBML患者均为女性,平均年龄44岁,患者均有子宫平滑肌瘤手术史,50%的PBML病例于体检发现,距首次子宫肌瘤手术时间为1个月~23年,中位时间为10年;影像学表现:82%表现为双肺或单肺多发结节灶,5%呈双肺散在粟粒样结节,5%合并有胸膜下肿块,9%合并其它部位转移、骨质破坏,所有病例均无淋巴结肿大、无胸腔积液。3例增强扫描病例中2例呈明显强化,1例无强化。4例接受PET-CT检查,均未见明显放射性浓集;86%病例雌激素受体(ER)及孕激素受体(PR)均(+),5%仅ER(+),5%仅PR(+)。结论 PBML患者多为有子宫肌瘤手术史的育龄期女性,多无明显临床症状。影像学多表现为肺内多发结节灶。育龄期女性于子宫肌瘤术后数年出现肺内多发结节时,在除外恶性肿瘤的同时要考虑到PBML的可能。     

残胃癌的临床特点及治疗探讨

目的探讨残胃癌的临床特点及手术治疗效果。方法对巢湖市第二人民医院普外二科2000～2011年收治的18例残胃癌患者临床资料加以总结分析。结果本组病例男性15例,女性3例,年龄38～79岁,首次手术胃肠重建方式BilrothⅡ式14例(78%),BilrothⅠ式3例(17%),胃空肠Roux-en-y吻合1例(0.5%)。癌灶发生于吻合口附近10例(55.5%),残胃小弯侧6例(30.3%),胃底贲门部位2例(14.2%)。18例中行根治性残胃切除8例(44.4%),姑息性残胃切除6例(30.3%),联合脏器切除5例(27.8%),剖腹探查+空肠造瘘4例(22.2%)。根治性切除组1、3、5年生存期分别为87.5%,50%,12.5%。姑息性切除组中位生存期平均为15个月,剖腹探查组均在1年内死亡。结论残胃癌多发生在残胃吻合口附近,以BilrothⅡ式胃大部切除术后常见,男性多于女性,就诊时多属于中晚期,联合脏器切除率高,根治性手术可提高生存率。     

肺泡蛋白沉着症9例临床分析

目的 探讨肺泡蛋白沉着症(PAP)的临床特征、疗效和预后.方法 回顾性分析经治的9例PAP患者的临床资料,并复习文献.结果 9例患者中,男4例,女5例;发病年龄29-65岁,平均年龄42岁;主要临床表现为进行性呼吸困难6例,咳嗽4例,咳痰2例,发热1例,2例无症状;胸部影像呈多样性,胸部高分辨率CT(HRCT)可呈地图样、铺路石样特征性改变.9例均经支气管镜肺活检(TBLB)和支气管肺泡灌洗(BALF)明确诊断.结论 PAP以呼吸困难、咳嗽为主要临床表现,HRCT地图样、铺路石样表现为影像学特征,TBLB和BALF是确诊的主要依据;全肺灌洗术是最佳治疗方法.     

儿童体位性心动过速综合征临床分析

目的：探讨儿童体位性心动过速综合征（POTS）的临床特征。方法：以符合POTS诊断标准的40例患儿为研究对象，分析年龄分布、家族遗传特征及血液动力学指标，同时观察其各种临床表现的发生频率及辅助检查结果。结果：诊断为POTS的患儿40例，其中男性15例，女性25例，男女比例为1：1．7，年龄10～16岁，平均为14±1．5岁，10例具有家族遗传性，占25％。最常见临床表现为直立后出现头晕、头痛、胸闷、心悸、面色改变、视物模糊、倦怠、晨起不适，严重时甚至出现眩晕、晕厥等直立不耐受或直立调节障碍症状。在直立试验（先安静平卧10min，然后直立10min）或直立倾斜（HUT）试验过程中，POTS患儿最常见的异常表现为在直立或倾斜后10min内，心率增加1〉35次／min，或患儿心率测最大值≥120次／min，但血压下降〈20／10mmHg为诊断标准。出现异常表现的时间平均为7±2min，15例直立6min出现异常症状，10例在直立后即可出现异常症状，15例作HUT约10min内出现异常症状。结论：POTS常见于学龄期女童，有一定的遗传性，常见的症状为头晕、胸闷、心慌等，HUT为诊断POTS敏感且重要的方法。