侧附鼻的病因学探讨及组织病理观察——文献复习附1例报告

1　病例报告　患者 ,男 ,17岁 ,出生时即发现左内眦与鼻根间有一管状突出物 ,有分泌物溢出 ,1岁时在外院诊断为“皮赘” ,予以单纯切除。于 1999年来我科就诊 ,检查有以下特征 :①左内眦部与鼻根间有一约 1.5cm长的陈旧性切口瘢痕。②左下睑缘近内眦部有一约 0 .5cm长的全层缺损、裂隙。③右侧鼻发育正常。④左侧鼻缺损。⑤头颅CT检查见 :左侧额窦未发育 ,左侧筛窦、上颌窦、鼻道发育不良 (图 1)。患者父母生育三子 ,其余二子均正常。其母孕期身体健康 ,患者足月顺产 ,除面部畸形外 ,其他脏器均正常。父母非近亲结婚 ,无其他家族遗传病史。…     

海洛因肾病的病理特征--附2例报告及文献复习

目的:探讨海洛因肾病的临床病理特征及其预后.方法:观察2例海洛因肾病的光镜、电镜和免疫组织化学特征,并复习有关文献.结果:2例均为男性,以肾病综合征入院.光镜和电镜见1例表现为局灶系膜增生性肾小球肾炎,1例为弥漫膜增殖Ⅰ型伴局灶肾小球硬化;免疫组织化学染色见IgM为主的免疫球蛋白沉积.结论:海洛因肾病为长期吸食海洛因导致的肾脏疾病,临床表现以肾病综合征多见,病理形态学、超微结构改变以及免疫组织化学染色无明显特异性,诊断需结合吸毒史并排除其他继发性肾病可能后诊断.     

类风湿性关节炎肾损害的组织病理改变——附4例报告及文献复习

目的 探讨类风湿性关节炎(RA)肾损害的组织病理学改变特点。方法 总结4例RA肾损害的临床病理资料，并结合文献进行分析。结果 4例均呈蛋白尿伴血尿，其中3例肾功能不全，组织病理为IgA肾病2例、节段系膜增生性肾炎及局灶节段性肾小球硬化各1例，文献报道临床表现以蛋白尿、血尿为主，可呈肾病综合征或伴肾功能不全，病理类型以系膜增生性肾炎(包括IgA肾病)、膜性肾病和肾淀粉样变性多见。结论 类风湿性关节炎的组织病理学改变以系镇增生性肾炎最常见，临床表现多样化。     

小肠脂肪瘤-附1例报告及文献复习

目的探讨小肠脂肪瘤的临床特征、影像学特点及治疗方法,以期提高对该病的认识,减少误诊和漏诊。方法对1例确诊为小肠脂肪瘤的病例资料结合文献作回顾性分析。结果小肠脂肪瘤病程长短依据症状的轻重而有所不同。临床症状与肿瘤大小、部位、生长方式及其并发症的类型有关。肿瘤较小时无症状,发病后可出现腹痛、消化道出血、腹部肿块等,严重时可导致肠梗阻、肠坏死等并发症。腹部平片及CT检查可以提高对小肠肿瘤的诊断率。结论重视临床病史的全面采集、细致的体格检查并进行腹部平片、CT检查,必要时可行MRI检查可以提高对小肠脂肪瘤的认识及诊断。     

膀胱癌肉瘤1例报告并附文献复习

目的结合文献复习,探讨膀胱癌肉瘤的临床特征及诊治水平。方法报告1例膀胱癌肉瘤患者的临床和病理资料,以无痛性肉眼血尿伴排尿困难为主要症状,CTU提示膀胱占位,膀胱镜下见巨大膀胱内肿物,活检病理提示癌肉瘤可能性大。结果行腹腔镜下全膀胱切除加回肠膀胱术,术后病理诊断为膀胱癌肉瘤,显微镜下主要由高分化移行细胞癌和肉瘤成分组成,辅以GC方案化疗。结论诊断依赖病理及免疫组化检查,膀胱癌肉瘤具有高度恶性和浸润性生长的生物学特性,治疗主要是以行根治性手术为主,预后不良。     

尿道淋巴瘤临床病理特征分析(附1例报告并文献复习)

目的:提高对尿道淋巴瘤诊断和治疗的认识。方法:报道1例尿道淋巴瘤患者临床病理特征及治疗,结合文献讨论其临床表现、病理类型、鉴别诊断、病因、治疗及预后。结果:临床诊断尿道肉阜,行病变切除术。病理检查:尿道外口黏膜上皮下见弥漫增生的大淋巴样细胞浸润,免疫组化染色CD20阳性,诊断为弥漫性大B细胞淋巴瘤。术后R-CEOP方案化疗6周期,随访21个月无复发。结论:尿道淋巴瘤好发于女性,需与尿道肉阜、尿道癌等鉴别。病变局限于尿道者预后相对较好,播散性病变预后较差。     

多发性内分泌肿瘤Ⅱb型--附1例报告并文献复习

目的:探讨提高多发性内分泌肿瘤Ⅱb型(MENⅡb)诊治水平和方法.方法:通过1例延误诊断多年MENⅡb病例诊治经验分析及文献复习,提出其诊断、治疗、预后的有关问题.结果:38岁女性,5年前以左侧肾上腺嗜铬细胞瘤为首发症状,行嗜铬细胞瘤切除术;3年前发现甲状腺右叶肿物,误诊为甲状腺腺瘤而随诊观察;半年前,再次因右侧肾上腺嗜咯细胞瘤而入院,患者伴有类马凡体型及多发性神经瘤,家族史提示具有一定的家庭遗传性,CT显示了典型的甲状腺髓样癌(MCT)钙化,确诊MENⅡb型,先后行嗜铬细胞瘤切除和MCT根治术,术后康复出院.结论:MENⅡb型是一种罕见疾病,加强对本病的认识是提高诊断的关键,治疗上应先行嗜铬细胞瘤切除后行MCT根治术,术后MCT复发和转移的监测与治疗是提高长期生存率的关键.     

后肾腺瘤临床及病理特点分析（附1例报告并文献复习）

目的：探讨后肾腺瘤的临床及病理特点。方法：报告1例后肾腺瘤患者的临床及病理资料．并复习相关文献予以讨论。结果：患者行根治性右肾切除术。镜下见肿瘤细胞大小一致．呈腺样及小管状排列．胞质少．细胞无明显异型性,核分裂像少见;免疫组织化学染色：WT1Vimentin、CK、EMA均阳性．Syn、RCC、SMA、HMB15、CD10、CD34、CgA、Chr均阴性;病理学诊断符合后肾腺瘤特点。术后随访18个月．未她肿瘤复发和远处转移。结论：后肾腺瘤是一种罕见的来源于肾脏上皮组织的肿瘤．了解该肿瘤临床及病理特点有助于临床诊断及鉴别诊断。     

胰腺肌周细胞瘤的病理特征及诊治（附1例报告并文献复习）

目的探讨胰腺肌周细胞瘤的病理特征及其诊治。方法报告本院收治的1例胰腺肌周细胞瘤,并复习近年来国内外文献肌周细胞瘤的临床病理特征、诊断、鉴别诊断、治疗及预后。结果胰腺肌周细胞瘤为具有嗜酸性/嗜双性的圆形、卵圆形细胞围绕血管腔形成的典型的同心圆状结构。血管周同心圆Υ排列的肌样细胞表达SMA及Actin阳性,而其他肌性标记物Desmin、S-100蛋白、HBM45及CD34等为阴性。结论胰腺肌周细胞瘤属于良性肿瘤,临床表现无特异性,确诊须靠病理组织学检查,完整切除肿瘤是本病的理想治疗方法。     

乳腺积乳囊肿的病因及诊治

本文报告乳腺积乳囊肿56例。年龄23～52岁,平均27.5岁。术前50例诊断正确,误诊6例。特别提出局部肿块波动感试验阳性,A超显示液平段,B起显示无回声,试穿抽出乳汁,对诊断有一定价值。治疗以手术切除为主;仅有7例穿刺抽吸乳汁得以治愈。     

臂外侧上皮神经的体表定位及其意义

本文在４４侧成尸上肢标本上观测了臂外侧上皮神经的走行及分布。确定了该皮神经浅出深筋膜处的体表位置，并探讨了与临床应用有关的问题。     

颗粒骨在人工全髋关节翻修术中的应用及研究进展

目的回顾近阶段国内外关于颗粒骨的临床应用与相关实验研究的进展. 方法广泛查阅近期有关颗粒骨临床应用与实验研究的文献,综述颗粒骨的应用方法与其作用机制的研究. 结果颗粒骨在临床应用中,特别是应用于人工全髋关节翻修术中取得了良好的效果,实验表明颗粒骨有很多优点. 结论颗粒骨应用效果良好,虽然其作用机制还有待于进一步研究,但必将会有良好的应用前景.     

THE ETIOLOGY OF POST-RADICAL PROSTATECTOMY INCONTINENCE AND CORRELATION OF SYMPTOMS WITH URODYNAMIC FINDINGS

Purpose

We evaluated men with post-radical prostatectomy incontinence to determine the incidence of intrinsic sphincter deficiency and bladder dysfunction, and the contribution of each to incontinence. In addition, we determined if subjective symptoms of stress urinary incontinence and urge incontinence correlated with urodynamic findings of intrinsic sphincter deficiency and bladder dysfunction, respectively.

Materials and Methods

A total of 60 consecutive patients (mean age 64.8 years) were prospectively evaluated with multichannel video urodynamics. All patients were evaluated at least 6 months postoperatively and had achieved a stable level of continence. Patients characterized incontinence as stress or urge related, and stress urinary incontinence was graded from 0 to 3. Intrinsic sphincter deficiency was defined as incontinence associated with increased intra-abdominal pressure and was further assessed by Valsalva's leak point pressure. Bladder dysfunction included urodynamic findings of detrusor instability or decreased compliance.

Results

Intrinsic sphincter deficiency was demonstrated in 54 patients (90%). Some component of bladder dysfunction was seen in 27 patients (45%), including detrusor instability in 24 and decreased compliance in 3, but incontinence was actually a result of bladder dysfunction in only 16 (27%). Incontinence was due to intrinsic sphincter deficiency alone in 40 patients (67%), intrinsic sphincter deficiency and bladder dysfunction in 14 (23%), and bladder dysfunction alone in only 2 (3%). Incontinence was not demonstrated on video urodynamics in 4 patients (7%). Of the 57 men who complained of stress urinary incontinence 54 demonstrated intrinsic sphincter deficiency for a positive predictive value of 95%. The 3 patients without stress urinary incontinence did not demonstrate intrinsic sphincter deficiency for a negative predictive value of 100%. Positive and negative predictive values for urge incontinence were 44 and 81%, respectively.

Conclusions

Incontinence after radical prostatectomy is associated with intrinsic sphincter deficiency in the overwhelming majority of patients. Bladder dysfunction rarely is an isolated cause. When present on urodynamic tests bladder dysfunction may not always be a significant contributor to incontinence. The symptom of stress urinary incontinence (or its absence) accurately predicts the finding (or absence) of intrinsic sphincter deficiency on urodynamics. Urge incontinence is not as reliable in predicting incontinence due to bladder dysfunction.     

ETIOLOGY,PROGNOSIS, AND OUTCOME OF POST-OPERATIVE ACUTE RENAL FAILURE

A Multivariate analysis was done in all patients who developed post operative ARF, during the period 1990–1995 to determine the etiological spectrum and to identify various variables affecting the outcome. Of 140 patients (110 operated at SGPGI and 30 operated outside) 116 underwent elective surgery. The different types of surgery leading to ARF were urosurgery (3.5%), open heart surgery (32.9%), gastrosurgery (16.4%), pancreatic surgery (9.3%), obstetrical surgery (3.6%) and others (2.8%). The incidence of ARF in SGPGI patients was highest in pancreatic surgery group (8.2%) followed by open heart surgery (3%). The different etiological factors responsible for ARF were perioperative hypotension (67.1%), sepsis (63.6%) and exposure to nephrotoxic drugs (29.3%). Sixty-four patients (45.7%) required dialysis. The overall mortality was 45% The mortality was highest in patients who underwent open heart surgery (89.1%) followed by pancreatic surgery (84.6%). The factors associated with high mortality, other than the type of surgery, were preoperative hypotension (p <0.05), oliguria (p <0.01), need for dialysis (p <0.05) and multiorgan failure (p <0.001). AM following emergency surgery had poor outcome, though not statistically significant. Perioperative sepsis (p <0.05) and preoperative use of aminoglycoside (p <0.05) were significantly higher in patients operated outside SGPGI. This was associated with higher incidence of ARF. Thus we conclude that presence of multiorgan failure, oligoanuria, preoperative hypotension and need far dialysis are poor prognostic markers in ARF following surgery.     

股前外侧皮瓣的多普勒探测研究和设计改进

目的改进股前外侧皮瓣设计方法,提高术前多普勒探测皮穿支的准确性。方法以股直肌和股外侧肌间隙为A线,A线上与髌骨外缘和髂前上棘连线中点对应的点,即A线的中点为A点,腹股沟韧带处股动脉搏动点与A点的连线为B线。在A线以外,大腿外侧中线以内,B线两侧3cm的范围内用多普勒血流探测仪探测穿支搏动点。使B线位于皮瓣横轴线的中外1/3,使最近探测点位于皮瓣纵轴线的中近1/3的位置设计皮瓣,皮瓣的长轴线与B线平行,如皮瓣较大,设计在A线与B线间。2001年11月~2004年10月,临床应用37例38个皮瓣。均为男性,年龄16~48岁。创伤性皮肤缺损6例,慢性创面深部组织外露22例,感染创面骨髓炎6例,瘢痕切除创面3例;其中手部创面8例,小腿及足踝部创面29例。皮瓣范围7cm×6cm~24cm×16cm。结果所有皮穿支穿出点均位于A线外侧,探测其形成皮瓣的有效动脉穿支符合率为97.4%。术后均获随访1~20个月,平均5.5个月。皮瓣全部成活35例36个,部分成活2个,其中4例第2足趾全部成活。发生静脉危象2例,动脉危象1例,经手术探查,完全成活2例,部分成活1例。28例伤口期愈合;3例行皮片移植修复;6例7个皮瓣覆盖骨髓炎创面者,有不同程度的深部伤口感染,其中4例形成窦道,经换药治愈,愈合时间1~11个月。皮瓣感觉:吻合神经6例S2~S3;未吻合神经S0~S1。供区直接闭合34例35处,皮片移植3例,均愈合良好。结论股前外侧皮瓣术前多普勒探测及B线引入,能提高皮瓣切取的成功率。     

MANAGEMENT OF CHRONIC ORCHIALGIA OF UNKNOWN ETIOLOGY

The treatment of patients with chronic unilateral or bilateral orchialgia, defined as intermittent or constant testicular pain of greater than 3 months and of unclear cause, is difficult. This pain significantly interferes with the daily activities of the patient. We have seen 12 patients with chronic orchialgia of unknown etiology and each had a normal history, physical examination and normal scrotal sonogram. Three patients were treated with nonsteroidal anti-inflammatory drugs and obtained partial pain relief. Three patients underwent spermatic cord nerve blockade using a combination of 1% lidocaine and 40 mg methylprednisolone and experienced partial pain relief. Four patients underwent inguinal orchiectomy after failing conservative management: three reported complete relief of pain, and the other partial relief. Two patients had bilateral transrectal injections of local anesthetic (5 ml bupivacaine) and methylprednisolone into the region of the pelvic plexus under transrectal ultrasound guidance. They were successfully treated with this injection technique. On the basis of our results, we recommend transrectal blockade of nerves from the pelvic plexus or inguinal orchiectomy as the procedure of choice for patients in whom medical treatment fails.