食管平滑肌瘤的外科治疗(附32例报告)

目的：探讨食管平滑肌瘤的诊断、治疗方法及其疗效。方法：分析手术治疗32例食管平滑肌瘤的临床资料。结果：单发型30例。多发型2例。肿瘤位于食管上段2例，中段27例，下段3例。行粘膜外肿瘤摘除术28例次，肿瘤及部分食管切除、食管胃主动脉弓上吻合术2例。弓下吻合术3例，肿瘤恶变后探查1例。手术切口为颈部切口3例次。右开胸20例．左开胸11例。本组病例无围手术期死亡。术后随访3年至10年，除1例肿瘤恶变者在术后5年死亡外，其他病例均生存。结论：手术切除是治疗食管平滑肌瘤唯一有效的方法，多数病例可行粘膜外肿瘤摘除术。少数肿瘤巨大或多发者需行肿瘤及部分食管切除、胃食管吻合术。如术后肿瘤复发需考虑肿瘤恶变。     

食管平滑肌瘤的外科治疗

目的　探讨食管平滑肌瘤的诊断方法、手术时机与手术方式的选择以及手术并发症的预防。方法总结 70例食管平滑肌瘤外科治疗的临床资料 ,结合文献复习 ,进行回顾分析。结果　全组病例术前经选择性地采用食管造影、食管镜、食管腔内超声、胸部CT扫描等方法检查 ;除因肿瘤 <1 0cm、无症状或症状轻微 ,合并症禁忌以及患者拒绝共 10例未手术外 ,手术治疗 6 0例 ;病理证实为平滑肌瘤 5 6例 ,平滑肌肉瘤 3例 ,平滑肌瘤合并食管鳞癌 1例 ;手术方式包括 :经胸前外或后外侧切口、腋窝S切口、不切断肌肉胸壁小切口、胸膜外及胸腔镜下粘膜外肿瘤摘除 ,食管部分切除、食管胃重建附加幽门成形术 ;术中食管粘膜破损 7例 ,术后声音嘶哑、食管狭窄各 1例 ,无围手术期死亡。结论　钡剂食管造影、食管镜检查仍为食管平滑肌瘤的基本、有效诊断方法。食管腔内超声探测、胸部CT扫描对于X线表现不典型、与恶性病变难以鉴别的病例 ,具有重要意义 ;基于食管平滑肌瘤系良性病变 ,提出对于病变小于 1 0cm、症状轻微、术中难以定位的患者 ,仅作追踪观察对象 ;对于体积较大、症状明显、或疑有恶性变者应根据肿瘤部位、大小、及性质确定手术入路及方案进行手术。强调术前如考虑为平滑肌瘤时 ,内镜下不宜咬取活检 ;术中剥离肿瘤时 ,应紧     

巨大食管平滑肌瘤的外科处理

食管平滑肌瘤为食管最常见的良性肿瘤,其诊断及外科治疗均有一定特点,其中巨大食管平滑肌瘤少见,易误诊,在处理上也有别于小的平滑肌瘤。作者对3例巨大食管平滑肌瘤患者的术前影像学、内镜资料及外科治疗方法进行回顾性分析,现报告如下。     

食管平滑肌瘤26例分析

食管平滑肌瘤是最常见的食管良性肿瘤,但发生较少。本文报告海军总医院,海军职工医院25年来经手术及病理证实的26例食管平滑肌瘤。     

食管平滑肌瘤的手术治疗

我院自1980至1995年，共收治食管平滑肌瘤7例，均行手术治疗，术后效果良好。临床资料：男5例，女2例；年龄35—55岁。病程在3个月至2年，有程度不同的吞咽困难5例；胸骨后疼痛、食后饱胀、上腹不适等消化道症状者2例。术前经食道吞钡摄片检查、胃镜检查、明确诊断6例。1例误诊为食道癌。病变均位于食管中下段。为单发、呈圆形或椭圆形。肿瘤最小直径1，5cm，最大为4．5×3×3cm，手术方法均采用左侧经胸标准后外侧切口，行粘膜外平滑肌瘤切除6例，1例因术前诊断为食管癌作食管下段切除．食管胃吻合术，术后病理诊断为食管平滑肌瘤。本组无…     

食管平滑肌瘤的手术治疗

我们自1980年至1994年，共收治食管平滑肌瘤7例。均行手术治疗，术后效果良好。临床资料患者中男5例、女2例；年龄35－55岁。病程3个月至2年。有程度不同的吞咽困难5例；胸骨后疼痛、食后饱胀、上腹不适等消化道症状者2例。术前经食管吞钡摄片检查、胃镜检查确诊6例；1例误诊为食管癌。病变均位于食管中下段，为单发，呈圆形或椭圆形。肿瘤最小直径1．5cm，最大为4．5ｘ3ｘ3cm。手术方法均采用左侧经胸标准后外侧切口，行粘膜外平滑肌瘤切除6例，1例因术前诊断为食管癌作食管下段切除，食管胃吻合术，术后病理诊断为食管平滑肌瘤。本组无手…     

食管平滑肌癌诊断中的几个问题（附15例分析）

食管平滑肌癌诊断中的几个问题（附１５例分析）吴锦良，章镜平，朱重新食管平滑肌瘤是一种少见的良性肿瘤。因其生长缓慢，临床症状轻微，常被延误诊断。为提高对本病的认识，现将我院自１９９２～１９９２年间经手术证实的１５例食管平滑肌瘤小结如下，并就其诊断问题作...     

食管平滑肌瘤13例临床分析

目的：探讨食管平滑肌瘤的临床诊断，治疗方法及效果。方法：诊断方面，本组１３例均作钡餐检查和食管镜检查，其中２例作ＣＴ检查。治疗方面：１１例作肿瘤摘除术，２例作食管部分切除，食管胃吻合术。结果：全组均手术治愈，无手术死亡或严重并发症。结论：食管平滑肌的临床诊断主要依赖钡剂造影，多轴位透视点片及食管镜检查有利于进一步明确诊断；手术是治疗本病的唯一方法，术式应尽可能采用肿瘤摘除术，此法较为简单，安全。术     

食管平滑肌瘤的诊断及外科治疗

目的　探讨食管平滑肌瘤的诊断及外科治疗特点。方法　对 14 1例食管平滑肌瘤患者的术前影像学、内窥镜资料及外科治疗结果进行回顾性分析。结果　食管平滑肌瘤患者的主要症状为吞咽不顺 (6 4 .5 % )及胸部或上腹部疼痛 (2 0 .6 % ) ,平均病史 15 .7个月。 11例术前误诊为食管恶性肿瘤、纵隔或腹膜后肿瘤。 13例行食管部分切除术 ,其中 2例肿瘤巨大 ,3例术中仍误诊为食管恶性肿瘤 ,8例并存食管癌或贲门癌。 12 8例行肿瘤摘除术 ,13例术中黏膜破裂并予以修补。肿瘤单发 130例 ,多发 11例。瘤体呈类圆形、马蹄形或不规则形 ,包绕食管周经 <1/ 2者 75例 ,>1/ 2者 5 9例 ,累及全周者 7例。肿瘤呈息肉状管腔内生长 1例 ,管壁外生长 2例 ,其余均管壁内生长。本组无手术死亡 ,手术并发症发生率 3.6 %。结论　食管平滑肌瘤易误诊为食管恶性肿瘤或纵隔肿瘤 ,应注意鉴别诊断。术式选择应尽可能行肿瘤摘除术。食管镜检查疑为平滑肌瘤时应避免活检。食管平滑肌瘤患者食管癌发病率较高 ,其原因有待探讨     

经内镜高频电切除术诊治微小食管平滑肌瘤

[目的]探讨经胃镜高频电切除术对食管微小平滑肌瘤诊断及治疗的意义.[方法] 54例食管微小平滑肌瘤患者,其中49例行高频电切除治疗,2例行外科手术治疗,3例随访观察.术后常规送切除组织行病理检查.[结果]在50例获得病理诊断中,确诊食管平滑肌瘤47例.临床诊断食管微小平滑肌瘤的符合率为94.0%(47/50),高频电切除成功率为90.7%(49/54).高频电切除治疗术后患者无食管穿孔等严重并发症发生,创面渗血2例(2/49);30例患者术后1个月～2年复查胃镜未见病变再发.[结论]胃镜下高频电切除微小食管平滑肌瘤安全、有效,有助于明确诊断,又可使其获得治疗.     

依维莫司联合索拉菲尼治疗复发难治性骨肉瘤的疗效及对血清TSGF、VEGF、Ras、ErbB3水平的影响

目的:探讨依维莫司联合索拉菲尼治疗复发难治性骨肉瘤的近远期临床疗效及对患者血清肿瘤特异性生长因子（TSGF）、血管内皮生长因子（VEGF）、Ras和ErbB3水平的影响。方法:选取我院2016年1月至2017年12月收治的二线放化疗（吉西他滨联合多西他赛）失败的复发难治性骨肉瘤患者60例,按照随机数字表法均分为观察组和对照组,每组30例。对照组患者给予索拉菲尼治疗,观察组患者在此基础上加用依维莫司进行治疗。观察两组患者的近远期临床疗效、中位无进展生存期（PFS）和中位总生存期（OS）,对血清TSGF、VEGF、Ras和ErbB3水平变化及不良反应发生情况进行比较。结果:观察组和对照组的疾病控制率分别为76.67%和50.00%,观察组明显高于对照组,两组之间有显著性差异(P<0.05)。治疗前两组患者TSGF、VEGF、Ras和ErbB3水平比较,差异无统计学意义(P>0.05);与治疗前相比,治疗后两组患者的TSGF、VEGF、Ras和ErbB3水平均显著降低,且观察组明显低于对照组,差异有统计学意义（P<0.05）。观察组患者中位无进展生存期（PFS）为39 天,中位总生存期（OS）为86天;对照组中位PFS为28天,中位OS为75天,观察组中位PFS和OS时间均优于对照组。观察组患者发生口腔炎的比例（73.33%）远大于对照组（6.66%）,两组患者手足皮肤综合征发生率均大于50.00%。其他不良反应如皮疹、高血糖、血小板减少等两组均有出现,但症状较轻,两组比较差异不明显。结论:依维莫司联合索拉菲尼治疗复发难治性骨肉瘤近远期临床疗效显著,能较好的控制病情进展,并且明显降低骨肉瘤患者血清TSGF、VEGF、Ras和ErbB3水平,不良反应较轻,耐受良好,总体疗效优于索拉菲尼单药治疗。     

Binding of FITC-labelled lectins to the gastrointestinal epithelium of the rat

Biotechnology uses lectin genes to transfect into crop plants for protection against insects and nematodes. On the other hand, the information is limited on lectin-binding properties of cells in the gastrointestinal tract. Therefore, binding of a panel of FITC-labelled plant lectins to gastrointestinal cells of the rat was studied. In the stomach, cytoplasmic staining of parietal cells by PHA appeared to be due to glycoproteins attached to the tubulovesicles. PNA also stained the parietal cells, but only in the isthmus and neck regions, reacting with desialylated glycoproteins. WGA bound to the mucous neck cells with higher affinity than to the surface and foveolar mucous cells. The mucous cells were also stained by SNA-I, UEA-I and, less intensively, by LCA. Chief cells did not show detectable reaction with any of the applied lectins. Binding of PHA to gastric cells showed differences when compared with the results of in vivostudies. Small intestinal brush border was stained with UEA-I and SNA-I, the latter lectin also strongly stained the surface of small intestinal crypts. Both lectins reacted with the mucus of goblet cells. In the large intestine UEA-I and SNA-I stained the goblet cells at the base and upper part of the crypts, respectively. Accordingly, we provided evidences for the unique lectin-binding phenotype of the various segments of the gastrointestinal tract.     

Applied vascular anatomy of the colon and rectum: clinical implications for the surgical oncologist

Surgery remains the most radical method of treatment of many solid tumors, including colorectal cancer; in these tumors, surgery is the only method that can offer the chance of cure. To avoid early postoperative morbidity (mainly, anastomotic leak) and to achieve good long-term results (low incidence of tumor recurrence, long overall and disease-free survival, and optimal quality of life), the surgeon should have an in-depth knowledge of vascular anatomy of the colon and rectum. This essential requirement is based on the fact that the actual course followed by lymph fluid drainage from any part of the colon/rectum is determined by its blood supply; therefore, the extent of resection for colorectal cancer follows the principles of blood supply and lymphatic drainage. Knowledge of the colorectal vascular anatomy and its variations is of vital importance in the planning of radical surgical treatment and in appropriately performing colorectal resections, particularly in the patient who underwent in the past colectomy or aortic surgery that has changed the usual pattern of collateral blood supply to the colon. This review summarizes currently available data regarding vascular anatomy of the colon and rectum, from a surgical perspective.     

Comparison of enzyme immunoassay and immunodiffusion for the detection of canine blastomycosis

Two Blastomyces dermatitidis commercial immunodiffusion antigens, Meridian Diagnostics and Nolan-Scott Laboratories, and two B. dermatitidis yeast phase lysate antigens, T-58 and K-Le, prepared in our laboratory were utilized in an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies in 61 serum specimens from dogs with blastomycosis. All antigens used in the ELISA were diluted to 50 ng of protein ml-1. Immunodiffusion (ID) tests were also performed on the sera using a Nolan-Scott ID antigen. Greater reactivity, based on the ELISA index value, was evidenced with the two yeast phase lysate antigens over the two commercial reagents in the ELISA. In addition the sensitivity of the ELISA with the T-58, K-Le and Meridian antigens was considerably greater than that of the ID test. The Nolan-Scott antigen, however, was able to detect more positive specimens when used in the ID procedure than in the ELISA. Therefore encouraging results were obtained with respect to the continued development and optimization of the ELISA using B. dermatitidis cell lysate antigens for the diagnosis of blastomycosis.     

Effect of tumor therapeutic irradiation on the mechanical properties of teeth tissue

Tumor irradiation of the head-neck area is accompanied by the development of a so-called radiation caries in the treated patients. In spite of conservative therapeutic measures, the process results in tooth destruction. The present study investigated the effects of irradiation on the demineralization and remineralization of the dental tissue. For this purpose, retained third molars were prepared and assigned either to a test group, which was exposed to fractional irradiation up to 60 Gy, or to a non-irradiated control group. Irradiated and non-irradiated teeth were then demineralized using acidic hydroxyl-cellulose gel; afterwards the teeth were remineralized using either Bifluorid12 or elmex gelee. The nanoindentation technique was used to measure the mechanical properties, hardness and elasticity, of the teeth in each of the conditions. The values were compared to the non-irradiated control group. Irradiation decreased dramatically the mechanical parameters of enamel and dentine. In nonirradiated teeth, demineralization had nearly the same effects of irradiation on the mechanical properties. In irradiated teeth, the effects of demineralization were negligible in comparison to non-irradiated teeth. Remineralization with Bifluorid12 or elmex gelee led to a partial improvement of the mechanical properties of the teeth. The enamel was more positively affected by remineralization than the dentine.     

Greek parents' reactions, difficulties and resources in childhood leukaemia at the time of diagnosis

Open-ended interviews were used to examine parental psychological reactions, difficulties and resources during the period following the diagnosis of childhood leukaemia. Data were obtained from 71 randomly selected mothers and fathers of children diagnosed with leukaemia at least 3 months prior to the study. The content analysis revealed a wide diversity of parental responses including many of the defensive mechanisms described in the literature such as shock, denial, anxiety and guilt. The most difficult factors for the parents to deal with during the initial period were the psychological upset and the financial burden. Problems associated with relating to others and to the health care system were also identified. Hope, social support and the marital relationship were the most helpful resources in managing the multifaceted problems caused by the diagnosis. Forty-five per cent of the participants felt that the quality of their marital relationship was improved, whereas fewer reported that the diagnosis seriously disturbed their marriage. Spouses were found to adopt symmetrical rather than complementary ways of responding to and coping with the event. Nurses have a key role in assessing the individual parent, the marital unit and the entire family system and planning appropriate interventions.     

Bioavailability,Skin-and Nailpenetration of Topically Applied Antimycotics*

Summary: The penetration and permeation of econazol, oxiconazol and dimethylmorpholinohydrochlorid in the human skin and nails have been performed using the measurement of radio labelled substances (C¹⁴? 250 μCi/ml) in vitro (penetration chamber) and in vivo. The penetration of the antimycotics inside the horny layer of the skin and the layers of the nail (10 μg/ml) ist sufficient enough to inhibit the growth of fungi by fungistatic mechanism. DMSO increases the penetration rate into the nail plate. Antimycotics solved in tinctures show a better penetration into the nails than the ointments which have advantages in penetrating the skin. The small fungicid effect and low dose in the deeper nails explains the long time topical treatment necessary at least for 6 months respectively the moulting process of the nail keratin.     

胶质瘤治疗热点的文献计量学分析

目的:脑胶质瘤是脑肿瘤中最常见的肿瘤，现目前常规治疗方式是手术切除辅以术后放化疗，但难以切除干净且易复发，预后不良。在此，我们将根据已发表的文献对胶质瘤的治疗领域进行热点及发展趋势研究。方法:我们检索了5年内与胶质瘤治疗主题最相关的13 017篇文献作为研究样本，通过Bicomb软件进行高频词分析及提取，建立了词篇矩阵及共词矩阵，使用gCluto软件对高频词矩阵进行双聚类分析及可视化分析得到热点领域的类别，并利用共词矩阵来构建胶质瘤治疗热点的战略坐标。结果:我们构建了54个高频主题词/副主题词与13 017篇文献的词篇及共词矩阵，并根据双聚类分析结果绘制了“山峰图”。通过共词矩阵及聚类分析得到的结果，计算出了各个热点在战略坐标中的密度和向心度。结论:在本研究中，我们总结了“胶质瘤的治疗”热点分为4类，同时，通过计算分析我们得出结论:胶质瘤的药物治疗是潜在热点领域，具有较大的潜在研究价值，处于探索阶段，有待更深入的研究。     

Estrogen-signaling pathway: a link between breast cancer and melatonin oncostatic actions

BACKGROUND: Melatonin exerts oncostatic effects on different kinds of tumors, especially on endocrine-responsive breast cancer. The most common conclusion is that melatonin reduces the incidence and growth of chemically induced mammary tumors, in vivo, and inhibits the proliferation and metastatic behavior of human breast cancer cells, in vitro. Both studies support the hypothesis that melatonin oncostatic actions on hormone-dependent mammary tumors are mainly based on its anti-estrogenic actions. METHODS AND RESULTS: Two different mechanisms have been proposed to explain how melatonin reduces the development of breast cancer throughout its interactions with the estrogen-signaling pathways: (a) the indirect neuroendocrine mechanism which includes the melatonin down-regulation of the hypothalamic-pituitary reproductive axis and the consequent reduction of circulating levels of gonadal estrogens and (b) direct melatonin actions at tumor cell level. Melatonin's direct effect on mammary tumor cells is that it interferes with the activation of the estrogen receptor, thus behaving as a selective estrogen receptor modulator. Melatonin also regulates the activity of the aromatases, the enzymes responsible for the local synthesis of estrogens, thus behaving as a selective estrogen enzyme modulator. CONCLUSIONS: The same molecule has both properties to selectively neutralize the effects of estrogens on the breast and the local biosynthesis of estrogens from androgens, one of the main objectives of recent antitumor pharmacological therapeutic strategies. It is these action mechanisms that collectively make melatonin an interesting anticancer drug in the prevention and treatment of estrogen-dependent tumors, since it has the advantage of acting at different levels of the estrogen-signaling pathways.     

Magnetic resonance imaging of ankle tendons and ligaments: Part I – Anatomy

Magnetic resonance imaging is an excellent technique for imaging the tendons and the ligaments of the ankle. Owing to the advantage of detailed demonstration of soft‐tissue structures and capability for multiplanar demonstration of the ankle ligaments and tendons, MRI has been increasingly used in the evaluation of the ligamentous and the tendon injuries of the ankle. Knowledge of normal anatomy and of MRI appearances are essential to recognize pathological appearances. In this pictorial essay, the first of a three part series, we review the normal MRI appearances of the ankle tendons and ligaments. The anterior, lateral and medial tendon groups, the Achilles tendon and the lateral, the syndesmotic and the medial ligament groups are described and illustrated. Anatomy of the sinus tarsi is also described. Tendon and ligament pathology will be illustrated in the second part of the series, and imaging approach to ankle injuries will be outlined in the final part of this series.