眼眶包虫囊肿的CT诊断(附4例报告)

作者分析了4例经手术、病理证实的眼眶包虫囊肿的CT表现。显示为眶内圆形或椭圆形,边界清楚的囊性病变。其CT值近似水的密度。增强扫描囊壁不增强或仅轻微增强。本病的CT表现颇具特征性,是诊断艰眶包虫囊肿安全可靠的理想检查方法。此外还对某些少见病例的鉴别诊断进行了讨论。     

Orbital pseudotumour as a presentation of paediatric ulcerative colitis

A 2-year-old girl presented with a one-day history of acute-onset bilateral painful, swollen eyes and a two-month history of loose stools. Physical examination revealed a right eyelid swelling with proptosis. Magnetic resonance imaging revealed a right orbital pseudotumour. The patient responded well to treatment with intravenous antibiotics and nonsteroidal anti-inflammatory drugs. However, three weeks later, she was readmitted with a vasculitic lesion over her left upper chest, with mucous-bloody diarrhoea. Histopathology confirmed the diagnosis of ulcerative colitis. The patient was treated with intravenous pulse methylprednisolone and sulphasalazine. Two weeks after discharge, she was readmitted for cutaneous vasculitis and worsening diarrhoea. The patient’s bowel and extraintestinal diseases resolved upon addition of infliximab to her treatment regimen. Her inflammatory markers also normalised. Azathioprine was subsequently added. Infliximab was discontinued after four doses and prednisolone was tapered off. The patient remained well without any flare-up after 24 months of follow-up.     

The occurrence of Helicobacter pylori in hydatid liver disease

Objective

To detect the prevalence of Helicobacter pylori (H. pylori) in hydatid liver disease.

Methods

A total of 58 patients with hydatid liver disease attending AL-Sadder Teaching Hospital in Al-Najaf and Al-Basrah governorate from February to August, 2008 were included in the study and served as group A. One hundred and twenty 1st degree relative patients (group B) and 20 normal persons including 10 male and 10 female (group C) as control were detected for the presence of H. pylori infection in general population. Chest X-ray was done for the above groups to exclude lung hydrated cyst. The patients were screened by ultrasound to obtain intra abdominal hydrated cyst and enzyme-linked immuno sorbent assay (ELISA) test was utilized to detect the H. pylori infection.

Results

Fifty eight patients from group A with hydatid liver disease, 30 male (51.7%) and 28 female (48.3%) were screened for the presence of H. pylori infection by using ELISA test. We found that 28 patients from group A had positive ELISA test including 19 male (32.8%) and 9 female (15.5%) (P<0.01). However, there were no positive results of H. pylori infection in group B and C by chest X-ray, ultrasound and ELISA test.

Conclusions

It can be concluded that there is a strong relationship between hydatid liver disease and presence of H. pylori.     

肝包虫囊肿钙化并多发结石4例

目的分析钙化性肝包虫囊肿并发结石的原因、诊断及治疗。方法依据病史,体征及B超、CT、包虫皮试作出诊断,4例病人均经手术治疗。结果术中证实为钙化单发性包虫囊肿与肝内胆道瘘,其中1例并腹腔破裂,经手术治愈。结论包虫囊肿结石甚为少见,它的形成与胆汁漏入其内及感染有关;有结石的包虫外囊壁均有钙化,囊壁钙化与结石形成之间的关系尚不清楚;包虫囊肿内结石均为多发性小结石。充满囊腔。本病的治疗与破裂肝包虫病的治疗相同。     

In vitro treatments of Echinococcus granulosus with fungal chitosan,as a novel biomolecule

Objective

To determined the antiparasitic activity of the isolated chitosan from Penicillium viridicatum, Penicillium aurantiogriseum and commercial chitosan against protoscolicidal of hydatid cysts were determined.

Methods

After isolating chitosan from fungal cell walls, four concentrations (50, 100, 200, 400 µg/mL) of each type of prepared chitosan and commercial chitosan were used for 10, 30, 60, and 180 min, respectively.

Results

Among different type of chitosan, commercial chitosan with the highest degree of deacetylation showed high scolicidal activity in vitro. Fungal chitosan could be recommended, as good as commercial chitosan, for hydatic cysts control.

Conclusions

It seems to be a good alternative to synthetic and chemical scolicidal.     

骨桥蛋白在肝包虫动物模型外囊壁中的表达

目的:观察动物模型肝包虫囊壁情况,研究骨桥蛋白(Osteopontin,OPN)在小鼠肝细粒棘球蚴外囊壁中的分布特征及表达相关因素,并探讨其意义.方法:肝包虫动物模型的制作、HE染色观察、免疫组化观察53例小鼠肝细粒棘球蚴外囊壁中OPN及巨噬细胞的表达与分布.结果:HE染色外囊的着色明显较周围巨噬细胞带深,不存在渐变的过程;83%肝细粒棘球蚴外囊壁中有不同程度OPN表达,且集中分布于肝包虫纤维囊壁(外囊),与外侧巨噬细胞带比较有显著差异(P＜0.01).结论:在动物模型上证明了外囊与肝实质间存在可分离间隙,OPN主要分布在肝细粒棘球蚴外囊,并在其形成过程中起重要作用.     

肝包虫病的螺旋CT诊断

目的:提高对肝包虫病的螺旋CT表现的认识。方法:回顾分析经本院螺旋CT检查及手术病理证实的21例肝包虫病螺旋CT表现。结果:囊型包虫病18例,其中单纯囊肿8例,表现为圆形水样密度区。多子囊型10例,表现为在一个大囊内可见数量不等的更低密度小圆形低密度区,边界清晰。钙化14例,为囊壁壳状钙化囊内不定形条片状钙化。包虫囊肿合并感染4例,表现为囊壁增厚,强化明显。泡型包虫病3例,呈不规则及不均匀密度影,所有病灶内均有钙化灶,其中1例病灶边缘有晕样改变区。所有病例CT均诊断正确。结论:螺旋CT可以很好显示肝包虫病病灶,对肝包虫病具有较高的诊断率。     

Splenic recurrence of liver hydatid cyst and spleen preserving therapy

Hydatid cyst disease remains a considerable public health problem, especially in pastoral and farming regions. Although the spleen is the third most commonly affected organ after the liver and lungs, splenic hydatid cyst is an uncommon entity even in areas that are endemic for echinococcosis. The recurrence rate after surgical therapy of the liver hydatid cyst is reported as 6.8-22.3 percent. Recurrences most frequently occur in the liver. Extrahepatic recurrences occur in the lung or peritoneum and the serosa of the abdominal organs. Splenic recurrence of liver hydatid cyst has not previously been reported. The most common surgical therapy is splenectomy, and the other option is spleen preserving surgery. We report the first case of recurrent splenic hydatid cyst in the spleen and liver synchronously after surgical therapy for liver hydatid disease. The patient was treated with liver resection and spleen preserving surgery.     

肝包虫术后残腔并发症的防治(附173例报告)

目的讨论肝包虫内囊摘除术后残腔并发症的防治方法。方法回顾分析我院1960年1月至2004年1月肝包虫内囊摘除术后外囊残腔并发症173例,占同期肝包虫手术的17．49％(173／989)。其中残腔感染104例(60．12％),残腔出血2例(1．16％),残腔胆汁漏51例(29．48％),钙化残腔不闭合13例(7．51％),残腔消化道瘘3例(1．73％)。87例(50．29％)经再次手术治疗。结果术后腹腔感染7例(8．05％),伤口感染11例(12．64％),肺部感染4例(4．6％),死亡3例(1．73％)。本组治愈率为98．27％。结论肝包虫内囊摘除术后残腔并发症发生率较高,其中以残腔感染及胆汁漏最为常见,部分病例治疗甚为困难,严重影响病人的生活质量甚至生命。包虫囊肿完整切除可有效地预防术后残腔并发症。近来有人提出包虫外囊与肝组织之间有一层疏松的结缔组织称为“外科膜”,该膜有利于包虫囊肿完整切除。作者认为包虫囊肿完整切除应根据病人的全身及局部情况和术者的经验而定,不可盲目从事。     

34例肝包虫CT诊断与分析

目的探讨肝包虫病的CT表现特征和病理基础,评价CT对肝包虫病的诊断价值。方法34例经手术病理证实的肝包虫患者,对其术前CT资料作回顾性对照分析。结果34例肝包虫诊断正确33例,误诊l例,诊断正确率为97．05％。结论肝包虫病有特征性的CT表现,CT可反映肝包虫不同时期的特征性病理改变,有很高的诊断价值。     

不同分型的囊型肝包虫囊内环境的研究

目的：探讨不同分型囊型肝包虫PH值、囊内压、渗透压及内囊生发层的变化是否存在一定的规律性。方法：应用精密PH值测定仪检测肝包虫囊肿囊液PH值的变化；采用穿刺测压法检测肝包虫囊肿囊内压力的变化；应用渗透压测定仪检测肝包虫囊肿囊液渗透压的变化；采用苏木素-伊红染色，观察肝包虫囊肿存活情况及内囊生发层病理组织学改变。结果：不同分型囊型肝包虫，其囊液的PH值、囊内压力、囊液的渗透压、内囊生发层的变化有显著差异（〈0.01）。结论：不同分型的囊型肝包虫随着其活性的变化，囊内环境亦呈有规律的变化。     

Isolated omental hydatid cyst--a case report

Isolated omental hydatid cyst is a very rare clinical entity. Here, such a case has been presented where abdominal cystic mass came out as isolated hydatid cyst in the greater omentum.     

Giant abdominal hydatid cyst masquerading as ovarian malignancy

Hydatid disease, caused by Echinococcus granulosus, is a common parasitic infection of the liver. Disseminated intra-abdominal hydatid disease may occur with the rupture of the hydatid cyst into the peritoneal cavity, producing secondary echinococcosis. Occasionally, the cyst may not rupture, and instead, enlarge, thus mimicking gross ascites or huge ovarian tumours. We present a 30-year-old woman with a giant intra-abdominal hydatid cyst communicating with the liver, and discuss the management of her case.     

11例肝包虫外囊剥除术临床初步观察

目的：探讨肝包虫外囊剥除术治疗肝包虫病的疗效。方珐：采用肝包虫外囊剥除术治疗11例肝包虫病患者。结果：全组病人术后恢复良好，无胆瘘、出血、感染等并发症。结论：肝包虫外囊剥除术治疗肝包虫病是一种合理而可行的新术式，可解决以往传统的内囊摘除术由于囊液外溢导致的复发问题，远期临床疗效尚需积累更多的病例和进行更长期的随访以进一步观察。     

48例肝包虫病诊治体会

目的探讨48例肝包虫患者的诊治体会。方法对1999-01~2005-06间收治的48例肝包虫病例资料进行回顾性分析。方法:外囊缝团术(8例),内囊摘除外囊缝合引流术(30例),网膜填塞术(10例)等处理方法。结果术后合并胆漏29例,均自愈。目前未见复发的病例,48例患者均获满意疗效。结论肝包虫病治疗以外科手术治疗为主,穿刺需谨慎,术中根据不同的情况采取不同的、合理的措施,可以获得满意的治疗效果。     

肾包虫囊肿的CT诊断(附3例报告)

本文报告经手术证实的3例肾包虫囊肿的CT表现。其特征性表现是:(1)卵圆形或圆形水样密度囊肿。(2)母囊内有子囊。(3)囊膜剥离征象。(4)囊壁钙化。并讨论了本病的破裂感染和与先天性肾囊肿的鉴别诊断。     

泡球蚴组织及囊液同工酶初步分析

应用 PAGE 法对多房棘球绦虫的泡球蚴囊液、全囊、原头蚴及囊壁组织的乳酸脱氢酶(LDH)、酯酶(EST)和酸性磷酸酶(AP)的同工酶进行了分析.结果 LDH 同工酶仅囊液与全囊各出现4条酶带.EST 同工酶全囊、囊液、原头蚴和囊壁分别出现14、17、3和13条酶带;而 AP 同工酶4种样品的酶带则分别是2、4、1和1条.3种同工酶的酶带数均以囊液样本为多且染色深,提示囊液可能是泡球蚴物质代谢的一个重要场所.     

Struma ovarii: management and follow-up of a rare ovarian tumour

INTRODUCTION

Struma ovarii represents about 1.0% of all ovarian tumours. While management involves surgery, there is a paucity of data regarding the extent and approach of surgery, and postoperative management. This study aimed to delineate the management of struma ovarii, its associated complications, and postoperative follow-up and investigations.

METHODS

We retrospectively reviewed cases of benign struma ovarii treated at KK Women’s and Children’s Hospital, Singapore, between January 2000 and May 2011.

RESULTS

A total of 68 patients underwent surgical removal of ovarian cyst or mass (24 cystectomy, 20 salpingo-oopherectomy and 24 total hysterectomy and bilateral salpingo-oopherectomy). Of the 68 surgeries, 39 (57.4%) included intraoperative frozen section sampling or procedures for staging of ovarian malignancy. The majority (73.5%) of surgeries were laparotomies. Histology revealed benign struma ovarii in all (98.5%) but one patient. Only 7 (10.3%) patients had postoperative complications – 3 wound-related, 2 thyroid-related, 1 incisional hernia and 1 nonspecific. The mean length of hospital stay was 4.2 days. During follow-up, 45 (66.2%) patients required no additional investigations. The most common investigation done was ultrasonography (n = 18, 26.5%). While no recurrences were diagnosed histologically, two patients were subsequently found to have complex/dermoid ovarian cysts on the ipsilateral side of the previous struma ovarii on ultrasonography.

CONCLUSION

Simple surgery is recommended for patients with struma ovarii, especially if they have fertility potential. Laparoscopic surgery is the recommended approach due to its shorter recovery time and lower morbidity. Most patients do not require extended periods of follow-up or postoperative investigations.     

Clinical Experience in Treating Intracranial Hydatid Cysts: Report of 97 Cases

Background: Echinococcosis is still endemic in many countries, including China, especially in its north-west part, but the world literature which describes the Chinese experience in treating the cerebral hydatid cyst is still lacking. In this report, clinical manifestations, radiological features and surgical outcomes of 97 patients with intracranial hydatid cysts were analyzed and the transmission pattern, preoperative diagnosis, treatment methods and long-term outcome were discussed. Methods: We retrospectively reviewed the clinical features ( neurological symptoms and signs), radiological manifestations( X-ray, CT, MRI) and surgical outcome of 97 patients with intracranial hydatid cysts whom received surgical treatment at the neurosurgical department of Xinjiang Medical University between the year 1985 to 2010.We have followed up the patients via sending questionnaire or telephone contact. Clinical outcome was evaluated by using Karnofsky Performance Scale Index (KPSI). Results: Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases, which include hemiparesis, visual deficit, diplopia and aphasia. Epilepsy was occurred in five patients with hemispheric hydatid cysts. On X-Ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round shaped and thin walled homogeneous low-density cystic lesion without surrounding edema and enhancement were the main findings on CT in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts were manifested as a heterodensity lesions. On MRI, Hydatid cyst was manifested as a round low signal lesion in T1-Weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts were manifested as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulted in two surgery related mortality. There was no other additional neurological deficit caused directly by surgery. Patient outcome was 97.2% with Karnofsky Performance Scale score 80 to 90. Conclusion: Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas. CT and MRI have been proven to be the best diagnostic modality for diagnosing intracranial hydatid cyst. Surgery is the treatment of choice for intracranial hydatid cyst whenever possible.     

肺包虫囊肿的影像学诊断

本文总结了４５８例肺包虫囊肿影像学诊断经验。典型Ｘ线征除罕见的环形囊壁鲈化外,只有破裂后形成液平面,上有漂浮膜或内囊周围有液体及气体形成双液平面。ＣＴ扫描包虫囊肿密度均匀,ＣＴ值２０Ｈｕ以下,偶见囊中之囊。Ｂ超声囊肿呈圆形或椭圆形无回声区。