Intrapericardial Ectopic Goiter: A Very Unusual Presentation

Mediastinal ectopic goiter is a thyroid tumor that lies entirely below a plane extending from the superior surface of the first thoracic vertebra to the suprasternal notch, and commonly lies in the vicinity of the thymus. Intrapericardial ectopic goiter is extremely rare. We present an extremely rare case of a 63-year-old woman with an intrapericardial ectopic goiter and review the pertinent literature.     

腹腔镜在异位妊娠保守手术中的应用

目的探讨腹腔镜在异位妊娠保守手术中的应用价值.方法回顾分析我院1999年12月～2004年3月168例异位妊娠保守手术病例,其中113例经腹腔镜手术,55例行开腹手术,比较两组的手术时间、术中出血量及术后妊娠率.结果113例腹腔镜手术中,109例(96.46%)顺利完成手术,4例(3.54%)中转开腹.腹腔镜手术组与开腹组相比,手术时间明显缩短(P＜0.001),术中出血量明显减少(P＜0.001),术后宫内妊娠率明显升高(P＜0.05).结论腹腔镜手术是异位妊娠保守手术治疗中安全、可靠的方法之一.     

Diagnosis and surgical treatment of ectopic adrenocorticotropic hormone-producing pulmonary tumors accompanied by Cushing syndrome

Malignant pulmonary tumors are rarely accompanied by Cushing syndrome. We encountered 4 patients with adrenocorticotropic hormone (ACTH)-producing pulmonary tumors (3 with carcinoid and 1 with small cell carcinoma). All patients were females aged 33–76 years. In the 4 patients, diagnostic methods, surgical procedures, stage, outcome, and immunohistological findings were evaluated. Subtotal resection of the anterior lobe of the pituitary gland had been performed in 3 patients. However, ACTH did not decrease, and further examination revealed pulmonary tumors. Preoperative blood sampling by catheter examination was performed in 2 patients, of whom 1 showed increased ACTH. Intraoperative blood sampling showed increased ACTH in 1 patient. Lobectomy combined with mediastinal lymph node dissection was performed in 3 patients and lobectomy alone (video-assisted thoracoscopic surgery) in 1. All patients showed a decrease in ACTH after operation without tumor recurrence. Diagnosis is possible by measuring ACTH in pulmonary arterial wedge blood obtained by catherization or in pulmonary venous blood obtained during operation. Surgical resection is effective for ectopic ACTH-producing pulmonary tumors.     

一种交叉异位融合肾新亚型及其诊治

目的:观察一种交叉异位融合肾新亚型的发病情况,探讨其临床分型、诊断与治疗以及发病机制。方法:回顾性分析1例交叉异位融合肾合并髂血管后巨输尿管异位开口和胸椎侧弯患者的临床资料,包括患者的病史资料、影像资料和手术探查交叉异位融合肾的术中所见,然后进行文献复习。结果:文献复习证实这可能是交叉异位融合肾的一种新亚型,交叉异位融合肾合并髂血管后异位输尿管在以前的文献中也从未见报道,患者的异位输尿结石并感染通过手术治愈。结论:男性的异位输尿管开口更为隐蔽,需要联合多种方法进行诊断。     

Ectopic Ureterocele with a Horseshoe Kidney in an Adult

A rare adult case of a left ectopic ureterocele associated with a duplex horseshoe kidney is reported. To the best of our knowledge, only one pediatric case of horseshoe kidney with an ectopic ureterocele has been reported. The present case was successfully treated by ureteropyelostomy, upper ureterectomy and unroofing of the ureterocele. The patient is currently followed with excretory urograms and renograms.     

Comparison of local tumor recurrence following excision with the CO2 laser, Nd:YAG laser, and Argon Beam Coagulator

This study compares the incidence of local tumor recurrence following primary excision with the CO2 laser, Nd:YAG laser (contact), Argon Beam Coagulator, or electrocautery. One hundred eight Fisher 344 rats with R3230AC mammary tumors (1.6 +/- 0.04 [SD] cm diameter) were used. All animals were randomized into groups of similar tumor size. In groups C and CS, excision was performed with a Sharplan 1060 CO2 laser (TEMoo, 25 W, continuous wave [CW], 0.2-mm spot size). Wounds in group CS were "sterilized" (0.5-mm spot size, 25 W, CW) by gently heating the wound without causing blanching or charring. In group N, a 0.4-mm contact Laser Blade and a Cooper 8000 Nd:YAG laser at 20 W CW was used. In groups SA1 and SA2, tumors were excised with the scalpel, and hemostasis and wound "sterilization" were accomplished with the Bard System 6000 Argon Beam Coagulator (ABC) at 40 W and 4 liters/min argon gas flow in SA1 and 12 liters/min in SA2. In group E, excision was accomplished at 40 W blend mode, 10 W spray mode. In group EA, excision was accomplished at 60 W cutting current, and hemostasis was achieved with the ABC. The animals were examined for evidence of recurrence for 34 days postoperatively. Mortalities were excluded from analysis. The incidence of recurrence was 11/14 (79%) in C, 6/16 (38%) in CS, 10/14 (71%) in SA1, 6/13 (46%) in SA2, 6/15 (40%) in N, 7/10 (70%) in EA, and 3/15 (20%) in E. Group E is statistically different (P less than .01) from groups EA, C, and SA1. Group C was different (P less than .01) from groups E, CS, and N. These results demonstrate an inverse relationship between tumor recurrence and local thermal effects at the surgical site. The ABC did not increase tumor recurrence. Contact YAG surgery was similar to CO2 laser excision and "sterilization." An attempt to study the influence of gas flow and pressure on local tumor recurrence and metastases should be made.     

腹腔镜保守性手术联合甲氨蝶呤预防持续性异位妊娠的临床价值

目的：探讨输卵管妊娠腹腔镜保守性手术后局部使用甲氨蝶呤（methotrexate,MTX）预防持续性异位妊娠（persistent ectopic pregnancy,PEP）的临床价值。方法：64例输卵管妊娠患者行保守性手术,研究组术后局部用MTK 20mg,比较两组术后血β—HCG值的下降水平及PEP的残生率。结果：研究组术后第3、7、12天的血β—HCG值下降水平、恢复至正常所需时间及PEP发生率均低于对照组（P〈0．05）。结论：腹腔镜保守性手术后局部使用MTX可预防持续性异位妊娠,术后监测血β—HCG值的变化,可早期发现持续性异位妊娠。     

Paraneoplastic pemphigus associated with a pericardial ectopic thymoma

Paraneoplastic Pemphigus (PNP), a rare autoimmune blistering disease, can be accompanied by both benign and malignant neoplasms. The most frequently reported associated malignancies include lymphomatoid and hematologic malignancies, Castleman's disease, carcinoma, thymoma. In a patient suspected of PNP, with no known history of malignancy, an extensive workup is suggested to look for underlying malignancy, which has to be treated to induce PNP remission. In this clinical case report, cross sectional imaging of a young female diagnosed with PNP, unveiled a pericardial mass lesion extending into transverse pericardial sinus. Excisional biopsy was performed. Histopathology revealed pericardial ectopic thymoma.     

腹腔镜治疗异位妊娠102例分析

目的:探讨腹腔镜手术治疗异位妊娠的临床效果及可行性。方法:回顾性分析我院2007年1月至2008年6月应用腹腔镜治疗102例异位妊娠患者的临床资料。结果:本组均顺利完成手术,无中转开腹,成功率100%。平均手术时间(40.15±5.35)min,术后6h进流食,6~12h拔除尿管。术后平均住院(3.5±0.9)d,无术后病率发生。结论:腹腔镜手术治疗异位妊娠,安全可行,可作为首选的手术方法。     

腹腔镜治疗异位妊娠伴失血性休克40例临床探讨

目的:评价异位妊娠伴失血性休克患者行腹腔镜手术治疗的有效性及可行性。方法:2006年7月至2008年7月我院共行腹腔镜手术治疗异位妊娠患者136例,其中伴休克症状40例。出血1 000~2 500ml,平均1 500ml。结果:40例失血性休克患者均成功施行腹腔镜手术,无并发症发生。结论:术者若具备熟练的腹腔镜操作技术,及时有效地抗休克治疗,理想的麻醉及监护,腹腔镜手术治疗异位妊娠伴失血性休克是安全可行的。     

异位ACTH综合征32例诊断和疗效观察

目的 对异位促肾上腺皮质激素(ACTH)综合征病例进行临床分析,为临床诊治工作提供指导。方法 对1990年1月至2003年4月间收治的32例异位ACTH综合征患者资料进行总结。结果 所有病例临床表现和生化测定均符合库欣综合征的诊断。10例患者找到异位肿瘤,诊断明确;4例患者经体表肿物活检或岩下静脉及股静脉插管分段取血查ACTH提示为异位ACTH瘤,诊断基本明确;18例患者经临床及影像学检查高度怀疑异位ACTH综合征。15例(47％)患者因异位肿瘤定位不明确而行双侧或单侧肾上腺全切术,1年存活率60％;7例(22％)患者发现可疑异位肿瘤,未行手术治疗,1年存活率0;10例(31％)患者行根治性肿瘤切除,6例为支气管类癌,4例为胸腺类癌,1年存活率60％。结论 异位ACTH综合征异位肿瘤定位极为困难,仅少数病例可以找到异位肿瘤行手术切除。多数病例无法确定异位肿瘤,双侧肾上腺全切加激素替代治疗是一种有效方法。     

异位中肾管囊肿合并异位睾丸恶变1例报告并文献复习

目的:报告1例罕见异位中肾管囊肿合并异位睾丸恶变病例,提高对本病的诊治水平。方法:回顾分析异位中肾管囊肿合并异位睾丸恶变的病例的临床资料,结合国内外相关文献,探讨异位中肾管囊肿合并异位睾丸恶变的发病机制、诊断及治疗。结果:经腹切除巨大囊肿及右侧异位恶变睾丸,左侧隐睾行下降固定,病理示"右异位中肾管囊肿,右侧异位睾丸精原细胞瘤",随访1年无转移。结论:异位中肾管囊肿合并异位睾丸恶变极为罕见,影像学检查可协助诊断,但最终需病理确诊,应早期行手术切除。后续治疗取决于隐睾恶变的病理类型及分期。     

Prenatal diagnosis of a large, cervical, intraspinal, neurenteric cyst and postnatal outcome

Neurenteric cysts are rare congenital anomalies derived from the notochord and located in front of the spinal column, mostly at the cervical level. They consist of an intraspinal cystic component that is connected to a mediastinal or thoracic cyst. A case of a cervical, intraspinal, neurenteric cyst, diagnosed at 28 weeks of gestation and operated on at 3 and half months after birth, is reported. Herein, we discuss important features of this case including its rare occurrence, intrauterine diagnosis, and early surgical intervention. In conclusion, the nature of prenatal intradural cysts should be fully evaluated and differentiated between neurenteric cyst and other types of cysts with fetal ultrasonography. Therefore, it is essential to be aware of this potential cyst in fetal ultrasonography in utero. Neurenteric cyst should be considered in the differential diagnosis of cervical intradural cystic lesions. In infants, successful surgery provides a cure in patients with cervical neurenteric cysts.     

Common sheath reimplantation with ureteral plication: A useful technique for the management of ectopic ureterocele

BACKGROUND: When salvaging the upper pole kidney in duplex ectopic ureterocele, primary bladder level surgery with common sheath ureteral reimplantation has the definite advantage of allowing the reconstruction of the entire collecting system through a single lower abdominal incision. However, there are several complications associated with a common sheath reimplantation in a child with a very dilated upper pole ureter, such as vesicoureteral reflux or ureterovesical stenosis. METHODS/RESULTS: To avoid these complications, ureteral plication over the common ureteral sheath in two children with duplex ectopic ureterocele was used. Postoperatively, neither child showed reflux or recurrent urinary tract infection and both showed a marked improvement of the upper pole collecting system. CONCLUSION: This technique allows for a simple and definitive reconstruction in cases of duplex ectopic ureterocele, particularly with dilated upper pole ureter.     

Thymic atypical carcinoid with Cushing''s syndrome manifesting in the terminal stage

A 56-year-old man with recurrent thymic atypical carcinoid presented with Cushing's syndrome only in the terminal stage. Eighteen months after the resection of an anterior mediastinal mass, he presented with hypernatremia and hypokalemia with high serum levels of adrenocorticotropic hormone and cortisol, and died two months later. An autopsy demonstrated multiple metastases of the tumro to the mediastinum, lungs, heart, liver, kidneys, bone, pituitary gland, and ocular muscles. The adrenocorticotropic hormone level of the tumor tissue was 26,000 pg/g.     

Testosterone immunoexpression in human Leydig cells of the tunica albuginea testis and spermatic cord. A quantitative study in normal foetuses, young adults, elderly men and patients with cryptorchidism

Summary. A semi-quantitative study of the extraparenchymal Leydig cells in the tunica albuginea testis and spermatic cord was performed on histological sections immunostained with anti-testosterone antibodies in the testes and spermatic cords obtained from human foetuses, adults and elderly men without testicular or related diseases (autopsy specimens), as well as from adult men with cryptorchidism (surgical specimens). The albugineal Leydig cells appeared in small groups in the vicinity of blood vessels. The Leydig cells of the spermatic cord usually appeared inside or around nerve trunks. The percentages of testes and spermatic cords with extraparenchymal Ley-dig cells were higher in the cryptorchid testis group than in the normal male groups. The number of Leydig cells per mm² in the tunica albuginea testis was higher in normal adult males than in foetuses. This number decreased in elderly men and increased markedly in cryptorchidism. The number of Leydig cells per mm² in the spermatic cord was also higher in normal adults than in foetuses and it did not change with either advancing age or cryptorchidism. In foetuses, the percentage of cells intensely immunostained by antitestosterone antibodies in the tunica albuginea and spermatic cord did not differ significantly from that found in the testicular parenchyma, whereas in the other three groups (adult, elderly, and cryptorchid men) the percentages of these cells in the tunica albuginea and spermatic cord were significantly lower than in the testicular parenchyma.     

上颌异位尖牙埋伏阻生的辅弓矫治

目的：探讨垂直曲式的片段辅弓应用在尖牙异位萌出的固定矫治方法。方法：对6例上颌异位尖牙用垂直曲式的片段辅弓支持下,固定正畸技术进行矫治。结果：6例在片段辅弓固定矫治器支持下,12个月左右异位尖牙进入牙弓排齐。结论：上颌异位尖牙通过正畸技术完全能排入正常牙列,不需拔除。     

腹腔镜手术治疗异位妊娠104例临床分析

目的：总结腹腔镜手术治疗异位妊娠的方法和经验。方法：分析腹腔镜手术治疗104例异位妊娠的方法和效果。结果：104例异位妊娠患者均顺利完成腹腔镜手术。平均手术时间为（40.0±15.0）min,平均住院4d,无并发症发生,治愈率100%。结论：腹腔镜手术治疗异位妊娠安全可靠,术后患者痛苦小,康复快。