充分重视胃癌腹膜转移的预防、诊断与治疗

腹膜是胃癌的常见转移部位，腹膜复发和转移约占所有胃癌术后复发类型的半数以上，而腹膜转移者的5年生存率低于20%。如何有效预防、诊断和治疗腹膜转移，是胃癌治疗领域极富挑战性的难题，也是进一步提高综合治疗疗效的关键问题之一。胃癌腹膜转移的机理研究迄今，胃癌腹膜转移的机理仍未明了。由于解剖和生理倾向性，腹膜转移多见于大网膜、膈肌和盆腹膜，其中大网膜是最早出现腹膜转移的部位。网膜相关淋巴组织参与腹膜腔液体的交换，有利于腹水中簇集的肿瘤细胞粘附于网膜；同时覆盖于其表面的间皮细胞呈松散连接并缺乏基底膜，也有利于…     

Back Pain in Children and Adolescents: Evaluation and Differential Diagnosis

Back pain in children and adolescents usually has a recognizable organic origin. The most common entities seen are spondylolysis, spondylolisthesis, Scheuermann's kyphosis, disk herniations, infections, and tumors. Early recognition and treatment can provide patients the best chance at relief of symptoms and eradication of the underlying disease process. The goals of this review are to (1) familiarize the clinician with the various diagnoses associated with back pain in the skeletally immature patient and (2) to assist the clinician in making the appropriate diagnosis by providing a rational method of selecting diagnostic tests that maximize specificity and minimize costs.     

Hepatic Adenoma and Focal Nodular Hyperplasia: Differential Diagnosis and Treatment

The diagnosis of benign hepatic tumors as hepatic adenoma (HA) and focal nodular hyperplasia (FNH) remains a challenge for clinicians and surgeons. The importance of differentiating between these lesions is based on the fact that HA must be surgically resected and FNH can be only observed. A series of 23 female patients with benign liver tumors (13 FNH, 10 HA) were evaluated, and a radiologic diagnostic algorithm was employed with the aim of establishing preoperative criteria for the differential diagnosis. All patients were submitted to surgical biopsy or hepatic resection to confirm the diagnosis. Based only on clinical and laboratory data, distinction was not possible. According to the investigative algorithm, the diagnosis was correct in 82.6% of the cases; but even with the development of imaging methods, which were used in combination, the differentiation was not possible in four patients. For FNH cases scintigraphy presented a sensitivity of 38.4% and specificity of 100%, whereas for HA the sensitivity reached 60% and specificity 85.7%. Magnetic resonance imaging, employed when scintigraphic findings were not typical, presented sensitivities of 71.4% and 80% and specificities of 100% and 100% for FNH and HA, respectively. Preoperative diagnosis of FNH was possible in 10 of 13 (76.9%) patients and was confirmed by histology in all of them. In one case, FNH was misdiagnosed as HA. The diagnosis of HA was possible in 9 of 10 (90%) adenoma cases. Surgical biopsy remains the best method for the differential diagnosis between HA and FNH and must be performed in all doubtful cases. Surgical resection is the treatment of choice for all patients with adenoma and can be performed safely. With the evolution of imaging methods it seems that the preoperative diagnosis of FNH may be considered reliable, thereby avoiding unnecessary surgical resection.     

高输出量性心力衰竭的诊断与治疗

有心衰的症状和体征、并伴有心输出量升高的心衰被称作“高输出量性心力衰竭”。伴有心衰的心输出量升高与多种疾病有关．包括：慢性贫血．全身性动-静脉瘘．脓毒症、高碳酸血症和甲状腺功能亢进症。发生这种病变的生理学基础是动-静脉分流或外周血管扩张所导致的全身血管阻力降低。这两方面原因都可以引起全身动脉压的下降和神经内分泌活动增强．进而导致心衰的临床表现。与低输出量性心力衰竭不同。关于高输出量性心力衰竭的临床试验比较缺乏。治疗心衰的常规疗法。如血管紧张素转化酶抑制剂、血管紧张素受体阻滞剂和一些能扩张血管的β受体阻断剂的应用．对于高输出量性心衰非但没效,反而会进一步降低全身血管阻力,使病情恶化。高输出量性心衰尽管少见,但常伴有一些可纠正的潜在病因。治疗方案比较局限：可以限制饮食中盐和水,并辅以利尿剂的适当应用。不建议使用血管扩张剂和β肾上腺素受体正性肌力药。     

非功能性甲状旁腺囊肿的鉴别诊断与治疗

目的探讨非功能性甲状旁腺囊肿的鉴别诊断与治疗。方法回顾性分析中国医科大学附属盛京医院普外科2003年1月至2013年4月期间收治的6例非功能性甲状旁腺囊肿患者的临床资料。结果6例患者术前均未确诊,其中4例诊断为甲状腺囊肿,1例笼统诊断为颈部肿物,1例仅注意了甲状腺病变。6例均行手术治疗,其中5例行左甲状旁腺囊肿切除术,1例同时行甲状腺癌根治、左甲状旁腺囊肿切除术。术后病理报告5例为甲状旁腺囊肿,1例为甲状旁腺囊肿合并右甲状腺乳头状微小癌。2例患者失访;4例患者随访9～24个月,平均19个月,均无甲状旁腺囊肿及甲状腺癌的复发或转移。结论非功能性甲状旁腺囊肿是真正意义上的甲状旁腺囊肿,临床少见,术前确诊率低。甲状旁腺囊肿切除术是一种安全而有效的治疗手段。     

Lesions Confined to the Sphenoid Ridge: Differential Diagnosis and Surgical Treatment

Tumors confined to the sphenoid ridge with little or no extradiploic extension are very rare; we describe here five patients with these lesions. Three were females and two males, with an average age of 33.4 years; the clinical presentation included proptosis and facial deformity. The diagnoses were three meningiomas (one “en plaque,” one globous, and one intraosseous) and two fibrous dysplasias (compact form). Although the radiological findings were similar, we could find some details to establish the differential diagnosis before the surgical procedure. All the lesions were totally removed without complications. In a follow-up period of 15 to 36 months none of the lesions has shown clinical or radiological evidence of recurrence. We discuss the pathophysiology of each case, and propose the pterional orbito-zygomatic approach as the best way to resect lesions in this location.