槽型化开窗联合抗生素骨水泥内置髓内钉治疗沙门菌与枯草杆菌致股骨慢性骨髓炎一例报道

<正>骨髓炎多见于创伤、术后、糖尿病足以及血源性骨髓炎等,其中对于创伤及术后骨髓炎的治疗目前已有较多报道,对于其致病菌,最常见的多属金黄色葡萄球菌,其次为铜绿假单胞菌^[1]。对于血源性引起的骨髓炎,最常见的患病人群是儿童,其发病机制多为身体某处的细菌随血液进行传播,这种传播一般为暂时性的菌血症所引起,因干骺端血液丰富、血流缓慢,细菌容易在长骨生长板附近的终末小动脉定居繁殖而发病^[2]。笔者在临床工作中,发现了1例因沙门菌、枯草杆菌引起的股骨慢性骨髓炎,经过     

利妥昔治疗后CD20丢失的复发弥漫性大B细胞淋巴瘤一例报道及文献复习(英文)

Nowadays,resistance to rituximab has become a major issue in clinical practice.And loss of CD20 may contribute to it.Here we presented a case of loss of CD20 expression in relapsed diffuse large B cell lymphoma treated with rituximab and discuss the incidence,mechanism,influence factors,specific markers,prognosis and treatment of this disease.These results suggested that a post-relapse biopsy after rituximab treatment should be performed.CD79a and Pax-5 should be used as the first-line B lineage-specific markers for these patients.Though mechanisms of CD20 decrement are not fully elucidated,the down-regulation of CD20 mRNA is the most probable hypothesis.Recently various new agents are developed,but the prognosis is still poor.Further studies for new treatments are needed.     

关节镜辅助下股骨远段交锁髓内钉微创取出术

目的 探讨关节镜辅助下股骨远段交锁髓内钉微创取出术比较常规切开手术的优势.方法 对我科1998年8月至2010年6月期间收治的31例股骨远段交锁髓内钉固定的患者采用关节镜辅助下交锁髓内钉微创取出术.平均手术时间、创伤大小、恢复时间,以及对膝关节功能影响方面与常规切开手术做了初步比较.结果 31例患者平均手术时间为45min,10d拆线,2周进行日常工作及活动.31例患者均获随访,随访时间6个月至12年,平均18个月,与常规切开手术相比:膝关节伤口小、愈合早、疼痛轻、下地早、膝关节功能均恢复好.结论 关节镜辅助下股骨远段交锁髓内钉微创取出术较常规切开手术切口小、创伤小、手术时间短、更安全、功能恢复好,更容易被患者接受.     

胸骨后甲状腺未分化癌1例报告并文献复习

目的:探讨胸骨后甲状腺未分化癌的临床特征和预后。方法:结合文献对1例胸骨后甲状腺未分化癌进行分析。结果:胸骨后甲状腺未分化癌,术前确诊较难,手术可解除压迫症状,但难以完整切除,预后差。结论:胸骨后甲状腺未分化癌应及时行影像学检查,尽早手术切除,并辅以放射等综合治疗。     

先天性纯红细胞再生障碍性贫血并发MDS—RCMD1例报道并文献复习

目的:先天性纯红细胞再生障碍性贫血(DBA)十分罕见,易并发各种肿瘤,治疗困难.通过1例先天性纯红细胞再生障碍性贫血(DBA)并发骨髓增生异常综合征-难治性血细胞减少伴有多系增生异常(MDS-RCMD)治疗转归及文献复习,并认识DBA.方法: 对我科收治的1例先天性纯红细胞再生障碍性贫血并发MDS进行病例分析及文献复习,并进行讨论.结果: 患者在应用全反式维甲酸(ATRA)、康力龙、活性维生素D3及肾上腺皮质激素、霉酚酸酯(MMF)等治疗后好转.结论: DBA虽然是一种罕见疾病,当并发恶性肿瘤后,预后极差,但经过综合治疗仍然可以好转.     

颅内上皮样血管内皮瘤一例报告并文献复习

上皮样血管内皮瘤(epithelioid hemangioendothelioma,EHE)是一种罕见的血管源性肿瘤,其组织学及生物学特性介于血管瘤和血管肉瘤之间,具有潜在复发和转移能力[1]。1982年Weiss等[2]在软组织中发现了这种独特组织类型的肿物,将其命名为EHE。EHE可发生于全身多个部位,最常见于肝、肺和骨,发生于颅内者非常罕见,文献报道其发病率不到颅内肿瘤的0.02%[3-4]。     

侵袭性系统性肥大细胞增生症一例并文献复习

目的 提高对侵袭性系统性肥大细胞增生症（ASM）诊断和治疗的认识.方法 回顾性分析1例ASM患者的临床资料及治疗经过,并复习相关文献.结果 作为系统性肥大细胞增生症（SM）的少见亚型,ASM以多脏器受累为主要临床特点,常伴有骨髓功能障碍、溶骨性损害或肝脾大等表现,提示机体肥大细胞高负荷状态.结论 ASM诊断除了必须符合SM诊断标准外,还须具备1项或多项“C”项所见.ASM患者预后影响因素诸多,准确的预后判断有助于临床治疗策略的制定,治疗应高度个体化.     

Primary Renal Angiosarcoma： One Case Report and Literatures Review

Introduction Angiosarcomas are rare highly malignant neoplasm that make up less than 2% of all soft-tissue sarcomas.Only 40 renal cases     

Liver transplantation for primary hepatic leiomyosarcoma: a case report and review of the literatures

Primary hepatic leiomyosarcoma (PHL), a malignant mesenchymal tumor of myogenic origin, is exceedingly rare. Patients may be afflicted with a wide spectrum of nonspecific symptoms, and most of the laboratory data are unhelpful to diagnosis. Here, we report a 44-year-old woman with anorexia and right upper quadrant pain who was diagnosed as having malignant hepatic tumor within the Milan criteria and treated by orthotopic liver transplantation (OLT), the pathologic diagnosis of PHL was made by postoperative immunohistochemical study. She underwent six courses of intravenous chemotherapy and enjoyed a 14-month tumor recurrence-free survival until the lymph node metastasis was detected, then we switched the tacrolimus to sirolimus and the patient survived for 20 months additionally. Unfortunately, she finally died of extensively lymphatic metastasis and cachexia. The diagnostic and therapeutic features of PHL are also discussed by reviewing the literatures. To our knowledge, this is the second report of administering OLT to PHL patients.     

原发性色素沉着性结节性肾上腺皮质病1例报道及文献回顾

目的:分析探索原发性色素沉着性结节性肾上腺皮质病（primary pigmented nodular adrenocortical disease,PPNAD）的临床表现、实验室检查特点、辅助检查特征及诊疗方案。方法:对空军军医大学第一附属医院泌尿外科收治的1例PPNAD患者的临床资料及国内文献所报道的46例患者临床资料进行回顾性分析。46例患者中男性16例,女性30例;其中44例表现为典型库欣综合征体貌,2例仅表现为高血压;伴Carney综合征(Carney complex,CNC)者16例,2例有甲状腺占位;疾病确诊年龄为11~58岁。实验室检查证实患者均具备促肾上腺皮质激素（adrenocorticotropic hormone,ACTH）非依赖性特征,大、小剂量地塞米松抑制试验均不被抑制者45例,1例被抑制,16例患者服用地塞米松后尿游离皮质醇（urinary free cortisol,UFC）升高。影像学完善头部MRI检查者发现垂体占位性病变者2例,无病变者20例,肾上腺CT检查可有双侧肾上腺多发结节或增粗、单侧肾上腺结节或肿物、单侧肾上腺增粗或未见明显变化等表现。治疗方式有腹腔镜下双侧肾上腺全切术、单侧肾上腺肿物切除术及单侧肾上腺全切术。结果:双侧肾上腺切除术联合术后终身激素替代治疗疗效确切,无复发;肾上腺次全切除术和单侧肾上腺切除术后无需激素替代治疗,但存在一定的复发风险。结论:PPNAD临床罕见,确诊主要依据病理检查,对于影像学检查阳性的非依赖性ACTH患者应高度怀疑本病。腹腔镜下双侧肾上腺切除联合术后激素替代治疗是目前治疗PPNAD的合理方案,具体术式应根据患者自身情况拟定。