肾上腺手术282例分析

为探讨肾上腺肿瘤的病种分布特点及诊断方法 ,对 1993年 3月～ 2 0 0 1年 12月住院行肾上腺手术的 2 82例病案资料行回顾性分析。其中男 135例 ,女 14 7例 ,年龄 4 3 6± 13 0岁 ;病变位于左侧 136例 ,右侧 131例 ,双侧 15例 ;肾上腺皮质肿瘤 16 1例 ,髓质肿瘤 75例 ,间叶病变 33例 ,转移恶性肿瘤 13例。有内分泌功能的肿瘤中以醛固酮增多症最多 ,为 83例 ,库欣综合征 2 7例 ,嗜铬细胞瘤 5 9例 (19例为意外发现 )。意外瘤共 10 5例(37 2 % ) ,恶性肿瘤共 36例 (12 8% )。肾上腺肿瘤的最大直径为 4 8± 3 4cm(0 3～ 2 2 5cm) ,醛固酮腺瘤最小 ,恶性肿瘤最大。2 82例术前诊断与术后病理诊断的符合率为 6 5 2 % ,其中有内分泌功能的皮质腺瘤符合率最高     

原发性醛固酮增多症

原发性醛固酮增多症 ,简称原醛症 ,是因肾上腺皮质发生肿瘤或增生 ,使醛固酮分泌过多 ,以高血压、低血钾、肌无力、高醛固酮和低肾素活性为主要特征的综合征。1　流行病学原醛症是继发性高血压的原因之一 ,在高血压人群中的患病率为 0 5 %～ 2 %。随着腹部B超、CT和MRI的广泛应用 ,许多无特征的病人也能被早期检出。Lim等从高血压 4 6 5例中筛检出原醛症4 3例 (占 9 2 % )。该症从新生儿至老人均可发病 ,但好发年龄为 30～ 5 0岁 ,其发病率在性别中没有差别 ,腺瘤多见于女性 ,男女之比约为 1∶1 2～ 1 5 ,国外报告为 1 2 3。2　病因…     

子宫肌瘤病理血管彻底性栓塞治疗的临床研究

目的　研究用聚乙稀醇颗粒 (PVA)彻底栓塞子宫肌瘤病理血管的临床效果。方法　对30例子宫肌瘤患者通过超选择性两侧子宫动脉插管 ,用直径为 2 5 0～ 35 5 μm的PVA 10 0～ 2 5 0mg将子宫肌瘤病理血管彻底栓塞。结果　 30例栓塞成功率 96 .7% ,随访 3～ 12个月。术后第 1个月月经恢复正常 2 6 /2 7例 ;贫血好转 2 0 /2 1例 ;下腹部坠痛不适减轻 15 /17例 ;肿块消失 1/3例 ;肿瘤压迫症状全部消失。术后 3个月瘤体平均缩小 40 %以上 ;术后 6个月瘤体平均缩小 5 0 %以上 ,其中 2例完全消失 ;术后 9个月瘤体平均缩小 6 0 %以上 ,其中 3例完全消失 ;无 1例出现严重并发症。结论　超选择性两侧子宫动脉插管将肌瘤病理血管用PVA彻底栓塞是子宫肌瘤安全、有效的治疗方法     

肾上腺占位病变的CT、MRI诊断(附71例报告)

目的探讨肾上腺占位病变的CT、MRI诊断价值,提高对肾上腺间质概念的认识. 资料与方法搜集1994年8月～2001年6月经手术和病理证实的肾上腺占位病变71例,46例行CT平扫,其中31例进行增强扫描;30例行MRI平扫,18例行增强扫描;共有5例行CT、MRI联合检查(平扫+增强). 结果 (1) 皮质占位36例(占50.7%),其中醛固酮腺瘤14例,皮质醇腺瘤11例,无功能腺瘤3例,皮质腺癌2例,皮质增生症6例;有1例伴性变态综合征.(2) 髓质占位29例(40.8%),其中嗜铬细胞瘤16例,成神经细胞瘤3例,节神经细胞瘤2例,转移瘤8例.(3)间质占位6例(8.5%),其中髓样脂肪瘤3例,囊肿2例,纤维脂肪瘤1例. 结论肾上腺占位病变多具有其特定的好发年龄、性别趋向及CT、MRI影像学特征,结合临床及实验室检查有助于提高占位病变诊断的准确性;但部分无功能腺瘤、转移瘤、间质肿瘤的定性诊断仍依赖于组织学检查.     

经动脉导管化疗对大肠癌组织学疗效和细胞凋亡的影响

目的　观察大肠癌术前经动脉导管化疗对大肠癌组织学疗效和细胞凋亡的影响。方法　 5 0例大肠癌术前经导管联合抗癌药物灌注治疗 ,介入化疗后 5～ 30d(平均 12d)外科手术切除肿瘤。切除标本作组织学疗效观察和细胞凋亡测定 ,其中介入治疗前 2 2例肠镜活检标本和 2 5例正常肠黏膜 (标本正常肠切缘 )作对照。结果　肿瘤组织学疗效Ⅰ级 2 0例 ,Ⅱ级 2 1例 ,Ⅲ级 9例。肿瘤凋亡细胞密度介入化疗前为 (31 4 7± 5 5 8)个 /网格 ,介入化疗后为 (76 6 9± 17 12 )个 /网格 ,正常肠黏膜为 (8 0 1± 3 39)个 /网格。凋亡细胞密度介入治疗后明显高于介入治疗前 (t =13.70 1,P <0 0 0 1) ,腺癌明显高于正常肠黏膜 (t=5 0 .978,P <0 0 0 1)。 5 0例中 5例失访 ,4 5例获得随访结果 ,1、3和 5年生存率分别为 95 1%、71 1%和 4 8 5 %。不同病理分期的组织学疗效之间差异无显著性意义 (χ2 =4 .6 96 ,P >0 30 )。组织学化疗反应和肿瘤细胞凋亡之间呈正相关 (F =7.73,P <0 0 1)。不同分化程度肿瘤的细胞凋亡比较差异无显著性意义 (t=0 .392 7,P >0 0 5 )。不同病理分期肿瘤的细胞凋亡比较差异也无显著性意义 (t=0 .0 0 1376 ,P >0 0 5 )。结论　大肠癌术前经导管动脉灌注化疗 ,肿瘤组织学疗效显著 ,肿瘤细胞凋亡     

血管内皮生长因子反义寡聚脱氧核苷酸与碘油混合栓塞治疗大鼠肝癌的实验研究

目的　观察血管内皮生长因子 (vascularendothelialgrowthfactor,VEGF)反义寡聚脱氧核苷酸 (antisenseoligodeoxynucleotides,asODN)抑制体外培养的Walker 2 5 6瘤细胞VEGF表达的情况 ,评价其与碘油混合行肝动脉栓塞对大鼠肝癌的治疗效果。方法　将反义和正义VEGF寡核苷酸加入无血清培养的Walker 2 5 6瘤细胞的培养液中 ,4 8h后酶联免疫吸附试验 (ELISA)法测定上清VEGF含量 ,并观察上清刺激血管内皮细胞 (ECV 30 4 )生长受抑情况。 30只Walker 2 5 6移植性大鼠肝癌模型数字法随机分成 3组 ,分别经肝动脉注入超液态碘油 (UFLP) 0 2ml(UFLP组 ,n =10 ) ,UFLP 0 2ml+VEGFasODN 3OD混合物 (UFLP +asODN组 ,n =10 ) ,生理盐水 0 2ml (对照组 ,n =10 )。于术前及术后第 7天行MR检查观察肿瘤的体积 ,用逆转录聚合酶链反应 (RT PCR)方法检测瘤内及瘤周VEGFmRNA含量 ,免疫组织化学法检测肿瘤组织VEGF的表达及微血管密度 (microvesseldensity ,MVD)。结果　VEGFasODN可以明显抑制培养的Walker 2 5 6瘤细胞VEGF的表达。动脉栓塞实验中 ,UFLP +asODN组肿瘤生长率明显低于UFLP组和对照组 [分别为 (14 0 1± 33 8) %、(177 9± 6 4 9) %和 (4 0 3 9±6 9 4 ) % ;F =6 0 0 2 ,P <0 0 1]。瘤内及瘤周VEGFmRNA含量     

CT导向穿刺治疗高血压脑出血

目的 :探讨定向穿刺术治疗高血压脑出血的方法和疗效。材料和方法 :通过CT导引定向穿刺治疗高血压脑出血患者 88例。男 5 0例 ,女 3 8例。年龄 3 6～ 83岁 ,平均 62 4岁。发病 6～ 12h手术 2 6例 ,12h以上手术 62例 ;3 0例单纯抽吸 ;2 0例溶凝后抽吸 ;3 8例溶凝 碎吸清除。结果 :术后 1个月内有效 80例 (90 9% ) ,并发症共 15例 (17 5 % ) (其中 7例术前即已发生 ) ;重残 11例 (12 5 % ) (早期手术 1例 ,延期 10例 ) ;死亡 8例 (9 1% ) (早期 2例 ,近期 6例 )。经 3个月至2年对 73例随访 ,ADL1～ADL3 67例 (91 8% )。结论 :定向穿刺术治疗高血压脑出血优于内、外科治疗 ;发病 6～ 12h手术可明显降低死亡率和重残率。预防再次脑出血的关键是血肿的一次排出量和排空速度分别在 5 0 %～ 80 %和 2ml/min ,脑室积血及并发症是死亡的主要原因     

肾动脉狭窄血管内治疗的临床疗效观察

目的　观察肾动脉狭窄血管内治疗的临床疗效。方法　对近 5年内 2 8例共 36支狭窄肾动脉行经皮肾动脉内支架成形术 (PTRAS)。术后 1个月、6个月、1年随访血压、血肌酐、抗高血压药用药情况 ,并与术前比较。术后 1年重复血管造影以判断再狭窄的发生率。结果　PTRAS技术成功率为10 0 % ,其原发通畅率为 82 % (肾动脉 86 % ) ,继发通畅率为 89% (肾动脉 90 % )。术后 1个月、6个月及 1年血压分别较术前有显著下降 (P <0 .0 1) ,血压控制的临床有效率 (治愈 改善 )分别为 10 0 %、92 .9%及 89.3% ;血清肌酐值、抗高血压药数目与基础值相比无显著差异。术后 1年 ,有 4例 (14 .3% )肾功能得到改善 ,18例 (6 4 .3% )肾功能保持稳定 ,6例 (2 1.4 % )肾功能恶化 ,其中 4例术前有肾功能不全病史 ;并发症包括 1例穿刺部位血肿及 3例一过性肾功能减退。结论　PTRAS操作简单、并发症少、技术成功率高、临床疗效佳 ,是肾动脉狭窄较为理想的首选治疗方法之一。     

肾上腺肿瘤的MRI诊断(附30例报告)

目的:分析肾上腺肿瘤的MRI信号特征与病理类型间的关系。方法:搜集1994年9月~2004年5月经临床手术和病理证实的肾上腺肿瘤30例,均行MRI平扫,其中23例行增强扫描。结果:功能性肾上腺肿瘤13例,其中醛固酮腺瘤5例,皮质醇腺瘤2例,嗜铬细胞瘤6例。无功能性肾上腺肿瘤19例,其中无功能腺瘤11例,神经节瘤1例,皮质腺癌2例,转移瘤3例。结论:MRI是诊断肾上腺肿瘤的较好方法,其化学位移反相位成像技术对鉴别腺瘤、嗜铬细胞瘤与恶性肿瘤具有更大优越性。     

经肝动脉化疗栓塞加血管生长抑制剂对兔肝移植瘤生长及转移的影响

目的　观察经肝动脉化疗栓塞术 (TACE)后血管生长抑制剂TNP 470治疗对兔VX2肝移植瘤生长及转移的抑制作用。材料与方法　将VX2肿瘤接种于日本大白兔的肝脏内 ,植入 2周后将 45只携有肿瘤的实验兔随机分为对照组、单纯TACE治疗组及TACE术后TNP 470治疗组 ,分别给予不同的处理。TACE术后TNP 470治疗组于TACE术后 3天给予TNP 470静脉灌注 ,隔日 1次 ,剂量为 30mg/kg体重 ,共治疗 9次。植入肿瘤后 5周处死动物 ,测量肝移植瘤的大小、坏死面积 ,观察肝内及双肺转移的发生率。结果　 5周末对照组肝移植瘤体积 2 6 .5± 6 .5cm3 ,平均坏死率 35 .5± 9.2 %。单纯TACE治疗后肝移植瘤体积约 19.9± 7.3cm3 ,平均坏死率 5 2 .4± 17.8%。TACE术后TNP 470治疗组移植瘤平均体积 14.7± 4.6cm3 ,平均坏死率 6 9.5± 12 .6 % ,各组之间对比有显著性差异 (P <0 .0 5 )。肝内及双肺转移率分别为 :对照组 :15 /15 (10 0 % )、11/15 (73.3% )。单纯TACE治疗组 :15 /15 (10 0 % )、10 /15(6 6 .7% )。两组之间无显著性差异 (P >0 .0 5 )。TACE术后TNP 470治疗组肝内及双肺转移率分别为 7/15(4 6 .7% )、5 /15 (33.3% ) ,与前两组比较有显著性差异 (P <0 .0 5 )。结论　单纯TACE治疗虽然能抑制肝移植瘤的生长 ,但对其转移无     

A case with primary hyperaldosteronism associated with chronic kidney disease

Primary hyperaldosteronism (PA) is one of the most common causes of secondary hypertension. PA may be associated with a decline in renal function. About 20% of cases with resistant HTN eventually cause PA, so all these patients should be evaluated for PA. Herein, we present a case with drug-resistant hypertension and chronic kidney disease (CKD), the cause of which was PA. Despite his low-salt diet modifications and treatment with several classes of antihypertensive medication, he had poorly controlled blood pressure (BP). Measurements of aldosterone and renin raised the concern of PA. Imaging confirmed bilateral adrenal hyperplasia. Due to the persistently high BP, despite the modification of the antihypertensive treatment, the patient underwent unilateral adrenalectomy, as the only feasible possibility of lowering aldosterone levels. After surgery, the patient had an improvement in both BP values and renal function. PA is difficult to diagnose in patients with CKD and Arterial Hypertension because hypertension is often associated with CKD, but PA accounts for a significant percentage of drug-resistant hypertension, so these patients should be screened for secondary arterial hypertension.     

肾上腺结节样增生性高血压的影像学检查(附117例分析)

目的:比较各种影像学检查对肾上腺结节样增生性高血压的检出情况,探讨多层螺旋CT薄层扫描在肾上腺结节样增生性高血压诊断中的优越性及临床意义。方法:回顾性分析2003年6月～2008年6月间手术病理诊断的肾上腺结节样增生患者117例,其中肾上腺皮质结节样增生112例,肾上腺皮质结节样增生伴髓质增生5例,分别行肾上腺超声、磁共振及多层螺旋CT薄层扫描。比较手术前后患者血压及生化指标变化。结果:行螺旋CT薄层扫描者112例,发现异常108例,检查阳性率96.4%,明确诊断105例,符合诊断率93.8%。螺旋CT薄层扫描对肾上腺结节样增生性高血压的符合诊断率显著优于B超(P0.01)及磁共振检查(P0.01)。117例均行腹腔镜患侧肾上腺全切术,106例术后血压恢复正常,手术有效率90.6%。结论:顽固性高血压患者怀疑为肾上腺结节样增生时,宜首先考虑行螺旋CT薄层扫描。肾上腺结节样增生性高血压患者应行腹腔镜患侧肾上腺全切术。     

CT动态增强鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值

目的探讨CT动态增强对鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值。方法回顾性分析经手术病理证实的12例肾上腺乏脂肪腺瘤和27例肾上腺结节样增生患者的病例资料,统计两组病例各期增强CT值,利用公式灌注值P=CT静脉期-CT平扫期、廓清值C=CT静脉期-CT延迟期、绝对廓清灌注指数APC=(C/P)×100%及相对廓清灌注指数RAPC=(C/CT静脉期)×100%得到相关参数,并通过绘制受试者工作特征曲线,鉴别两者的最佳价值。结果肾上腺乏脂肪腺瘤直径较结节样增生更大;肾上腺乏脂肪腺瘤病灶各期CT值均明显高于结节样增生,且两者灌注值P、廓清值C、APC及RAPC有明显的统计学差异。年龄、性别、高血压、病灶位置、对侧肾上腺萎缩及动脉期CT值对鉴别两者无显著意义。结论CT动态增强扫描有助于鉴别肾上腺乏脂肪腺瘤和肾上腺结节样增生。     

Adrenal venous sampling for stratifying patients for surgery of adrenal nodules detected using dynamic contrast enhanced CT

PURPOSE

We aimed to assess the value of adrenal venous sampling (AVS) for diagnosing primary aldosteronism (PA) subtypes in patients with a unilateral nodule detected on adrenal computed tomography (CT) and scheduled for adrenalectomy.

MATERIALS AND METHODS

This retrospective study included 80 consecutive patients with PA undergoing CT and AVS. Different lateralization indices were assessed, and a cutoff established using receiver operating characteristic curve analysis. The value of CT alone versus CT with AVS for differentiating PA subtypes was compared. The adrenalectomy outcome was assessed, and predictors of cure were determined using univariate analysis.

RESULTS

AVS was successful in 68 patients. A cortisol-corrected aldosterone affected-to-unaffected ratio cutoff of 2.0 and affected-to-inferior vena cava ratio cutoff of 1.4 were the best lateralization indices, with accuracies of 82.5% and 80.4%, respectively. CT and AVS diagnosed 38 patients with aldosterone-producing adenomas, five patients with unilateral adrenal hyperplasia, and 25 patients with bilateral adrenal hyperplasia. Of the 52 patients with a nodule detected on CT, subsequent AVS diagnosed bilateral adrenal hyperplasia in 14 patients (27%). Compared to the results of combining CT with AVS, the accuracy of CT alone for diagnosing aldosterone-producing adenomas was 71.1% (P < 0.001). The cure rate for hypertension after adrenalectomy was 39.2%, with improvement in 53.5% of patients. On univariate analysis, predictors of persistent hypertension were male gender and preoperative systolic blood pressure.

CONCLUSION

To avoid inappropriate surgery, AVS is necessary for diagnosing unilateral nodules with aldosterone hypersecretion detected by CT.Primary aldosteronism (PA) is the most common form of secondary hypertension, with a prevalence of 5%–11% (1–3). PA is due primarily to the hypersecretion of aldosterone by an aldosterone-producing adenoma (APA) or unilateral (primary) adrenal hyperplasia (UAH), which constitute 30%–40% of cases; the remainder are presumed to be secondary to idiopathic bilateral adrenal hyperplasia (BAH) (1, 4, 5). APA and UAH are two forms of unilateral aldosterone hypersecretion, and both are curable with adrenalectomy. BAH induces bilateral aldosterone hypersecretion, and anti-aldosterone drugs are used in its medical management (5–7).The plasma aldosterone-to-renin ratio is used to screen for PA in patients at high risk for PA (8). Recent guidelines recommend using computed tomography (CT) of the adrenal gland to categorize the subtype after confirming PA. However, CT cannot reliably visualize a microadenoma or distinguish between an incidentaloma or BAH and APA. It has been suggested that adrenal venous sampling (AVS) be performed to determine the subtype of PA and to differentiate between unilateral and bilateral production of aldosterone preoperatively (9). AVS to measure the adrenal vein aldosterone and cortisol is the gold standard for lateralizing aldosterone secretion (10). Lateralization is defined using several ratios. In patients with APA or UAH, a unilateral adrenalectomy results in a complete cure or improved hypertension and potassium normalization in approximately 30% of patients, with reported rates up to 86% (11–15).This study assessed several lateralization ratios to establish the most predictive of unilateral disease. We also compared the CT results with those of bilateral AVS for differentiating the PA subtype, with the assumption that AVS is necessary before surgery, even in patients with nodules <10 mm detected with CT. Finally, we assessed the outcomes of adrenalectomy in our patients to identify preoperative predictors of a good outcome.     

Effectiveness of Thermal Ablation for Aldosterone-Producing Adrenal Adenoma: A Systematic Review and Meta-Analysis of Clinical and Biochemical Parameters

PurposeTo assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma.Materials and MethodsA systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated.ResultsA total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (−29.06 mm Hg; 95% confidence interval [CI], −33.93 to −24.19), DBP (−16.03 mm Hg; 95% CI, −18.33 to −13.73), and the number of antihypertensive medications used (−1.43; 95% CI, −1.97 to −0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration.ConclusionsThermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results.     

高血压脑出血患者手术治疗及血压控制情况随访观察

目的分析手术方法治疗高血压脑出血的疗效及术后血压控制情况。方法对2007~2010年在我院接受手术治疗的高血压脑出血患者211例病例资料进行分析并对术后血压控制情况进行随访观察。结果术后24～72h复查CT,血肿完全清除46例,90%以上清除104例,60%～90%清除26例,清除不足60%为丘脑出血破入脑室者35例。211例患者中未出现术后再出血,术后并发症有肺部感染15例,消化道出血17例,急性肾功能衰竭3例。术后4周,恢复良好120例,中度残废42例,重度残废37例,死亡12例（术前脑疝、合并心肌梗死、2型糖尿病）,术后1月死亡率5.69%。术后对患者进行降压治疗健康教育,术后3个月、6个月随访中,达标率不高,在随访中不断对患者进行高血压相关知识宣教,嘱患者坚持规律服用药物,在术后1年及2年随访中,达标率逐渐提高。后2年随访中,所有患者未再出现脑出血,通过康复功能治疗后,中度残废59例,重度残废20例。结论高血压脑出血外科治疗应选择最佳术式,结合显微操作技术,清除血肿,减少脑组织损伤,减少并发症。手术治疗脑出血是重要手段,但手术后患者长期血压控制达标对于改善患者预后及预防再次脑出血更为重要,作为外科医生在对手术患者随访的同时,进行血压情况的随访同样重要。     

Prognostic value of semiquantification NP-59 SPECT/CT in primary aldosteronism patients after adrenalectomy

Purpose

Primary aldosteronism (PA), characterized by an excessive production of aldosterone, affects 5?13 % of patients with hypertension. Accurate strategies are needed for the timely diagnosis of PA to allow curability and prevention of excessive cardiovascular events and related damage. This study aimed to evaluate the usefulness of semiquantification of ¹³¹I-6β-iodomethyl-norcholesterol (NP-59) single photon emission computed tomography (SPECT)/CT in differentiating aldosterone-producing adenoma (APA) from idiopathic adrenal hyperplasia (IAH) and in predicting clinical outcomes after adrenalectomy.

Methods

We retrospectively reviewed 49 PA patients who had undergone adrenalectomy after NP-59 SPECT/CT within 1 year. A conventional visual scale (VS) and two semiquantitative parameters generated from SPECT/CT, adrenal to liver ratio (ALR) and lesion to contralateral ratio of bilateral adrenal glands (CON), with cutoff values calculated by receiver-operating characteristic (ROC) analysis, were compared with pathology results and postsurgical outcomes to determine the accuracy.

Results

An ALR cutoff of 1.84 and a CON cutoff of 1.15 showed an ability to distinguish adenoma from hyperplasia similar to VS (p?=?0.2592 and 0.1908, respectively). An ALR cutoff of 2.28 and a CON cutoff of 1.11 yielded the highest sensitivity and specificity to predict postsurgical outcomes, and an ALR of 2.28 had an ability superior to VS (p?=?0.0215), while a CON of 1.11 did not (p?=?0.1015). Patients with either ALR or CON greater than the cutoff had a high probability of positive postsurgical outcomes (n?=?36/38), while patients with both ALR and CON less than the cutoff had a low probability of positive postsurgical outcomes (n?=?2/11).

Conclusion

Semiquantification of NP-59 scintigraphy has an ability similar to VS in differentiating APA from IAH, but an excellent ability to predict postsurgical outcomes of adrenalectomy. An ALR or CON greater than the cutoff strongly suggests benefits from adrenalectomy, and both ALR and CON less than the cutoff implies a reduced chance of improvement in postsurgical outcome.     

颅脑外伤去骨瓣减压术后并发脑梗死危险因素分析

目的 探讨颅脑外伤患者去骨瓣减压术后并发脑梗死的相关危险因素,为其预防提供参考.方法 将68例颅脑外伤去骨瓣减压术后并发脑梗死患者作为观察组,另外89例未并发脑梗死患者作为对照组,对相关因素进行单因素及多因素回归分析.结果 颅脑外伤去骨瓣减压术后脑梗死发生率为43.3%,病死率为23.5%.单因素分析发现,年龄＞60岁、高血压、糖尿病、冠心病、陈旧性脑梗死、GCS昏迷评分＜8分、神经系统阳性体征、休克、急性硬膜下血肿、脑挫裂伤、损伤程度、入院时间与术后脑梗死发生相关.多因素分析发现年龄＞60岁、伴高血压、伴糖尿病、伴冠心病、伴陈旧性脑梗死、GCS昏迷评分＜8分、有神经系统阳性体征、轻度损伤、中度损伤、入院时间＜4 h为相关因素,其中轻度损伤、中度损伤、入院时间＜4 h为保护性因素,其余7项为危险因素.结论 年龄＞60岁、伴发心脑血管疾病或糖尿病、受伤程度、GCS评分等与颅脑外伤患者去骨瓣减压术后并发脑梗死相关,正确认识这些危险因素对其防治具有指导意义.     

Preoperative diagnosis and localization of aldosteronomas by measurement of corticosteroids in adrenal venous blood.

Adrenal venous aldosterone/cortisol ratios were determined in 14 patients with primary aldosteronism. Of 12 patients diagnosed as having an adrenal adenoma, ten underwent surgery in which an adenoma was found. Bilateral adrenal hyperplasia was thought to have developed in two other patients. Measurement of adrenal vein cortisol and establishment of aldosterone/cortisol ratios were done to correct for catheter placement and dilute adrenal efflux. Determination of steroids after ACTH stimulation was helpful in distinguishing quiescent from suppressed adrenal in two patients and in confirming the diagnosis of the others.     

CT of primary hyperaldosteronism (Conn's syndrome): the value of measuring the adrenal gland

OBJECTIVE: The objectives of our study of patients with primary hyperaldosteronism (Conn's syndrome) were to determine whether the adrenal glands are larger in patients with bilateral adrenal hyperplasia than in those with aldosterone-producing adenomas or in healthy control subjects; and whether a CT criterion based on adrenal gland size can be developed to positively diagnose bilateral adrenal hyperplasia. MATERIALS AND METHODS: A retrospective study of CT scans of 28 patients with primary hyperaldosteronism was performed. The means of two observers' measurements of adrenal gland size were recorded and compared with published normal values. In addition, a radiologist experienced in adrenal imaging and unaware of the cause of the primary hyperaldosteronism diagnosed either bilateral adrenal hyperplasia or aldosterone-producing adenoma by visual inspection. RESULTS: The adrenal glands in patients with bilateral adrenal hyperplasia were significantly (p < 0.05) larger than those in patients with aldosterone-producing adenoma or in healthy control subjects. A sensitivity of 100% was achieved when a mean limb width of greater than 3 mm was used to diagnose bilateral adrenal hyperplasia, and a specificity of 100% was achieved when the mean limb width was 5 mm or greater. Receiver operating characteristic curve analysis showed that the overall performance of the radiologist and the mean adrenal limb width in detecting bilateral adrenal hyperplasia were equivalent. CONCLUSION: In patients with primary hyperaldosteronism, adrenal limb measurements on CT can aid in differentiating bilateral adrenal hyperplasia from aldosterone-producing adenoma because the adrenal glands in bilateral adrenal hyperplasia are larger.