Gastric interposition following transhiatal esophagectomy: Radiographic evaluation

Gastric interposition was achieved in 138 patients following transhiatal esophagectomy without thoracotomy. Among these, 33 had benign and 105 malignant lesions. All patients were evaluated on the 10th postoperative day with a barium swallow examination. However, if an anastomotic leak was suspected clinically before this time, a water-soluble contrast study was initially obtained. Early postoperative complications included anastomotic leaks (15), cricopharyngeal incoordination with aspiration (6), and gastric perforation (2). Late postoperative complications included anastomotic strictures (12), pyloric stenosis (4), recurrence of tumor (3), and transhiatal visceral herniation (2). Our technique of postoperative radiographic evaluation, particularly when a leak is suspected clinically, is discussed.     

Diverticular complications of renal failure

Ten patients with chronic renal failure presented with complications of colonic diverticula. Five had acute diverticulitis, 4 perforated diverticula, and 1 lower gastrointestinal hemorrhage. Symptoms were less severe than expected. In 3 the diagnosis was first suspected when free intra-abdominal air was detected. Seven patients had laparotomy, 5 emergently. Radiologists should be aware of the potential for diverticular complication in patients with renal failure, even with minimal or absent symptoms. Suspicion of colonic pathology either clinically or radiographically should be evaluated promptly so that aggressive therapy can begin.     

Metachronous colonic lymphomas complicating chronic ulcerative colitis

The gastrointestinal tract is the most common extranodal site of primary non-Hodgkin's lymphoma. Of these, 10–15% occur in the large bowel. Colonic lymphoma is a recognized complication of inflammatory bowel disease, particularly ulcerative colitis and, less commonly, Crohn's disease. We describe a unique case of two metachronous primary lymphomas of the large bowel in a patient with chronic ulcerative colitis.     

Diagnosis of colonic varices by air-contrast barium enema examination: Report of a case

A case of colonic varices presenting as serpiginous and tubular submucosal lesions in the sigmoid on air-contrast enema examination is reported. The associated angiographic and colonoscopic findings are illustrated, and the pertinent literature is reviewed.     

Pathogenesis of giant colonic diverticula

The clinical, radiographic, and pathologic findings of 3 patients with giant colonic diverticula are presented. Although several theories have been proposed for the formation of these diverticula, they have not been fully documented. One of our cases illustrates the evolution of this disorder following typical colonic diverticulitis. The pathogenesis and differential diagnosis of this unusual entity are discussed.     

Plasmacytoma of the large bowel: A review of the literature and a case report of multiple myeloma involving the rectosigmoid

Large bowel involvement is a rare manifestation of plasma cell tumors, especially in association with multiple myeloma. A review of the world literature reveals only 21 reported cases, the majority of which are classified as the solitary form of the disease. A case of multiple myeloma with rectosigmoid involvement is herein presented, and the radiological findings of reported cases are summarized.     

Radiology of cholecystectomy complications

Postoperative problems following simple removal of the gallbladder are infrequent. Radiographic studies may be valuable in suggesting or confirming the diagnosis when not clinically evident. Plain films, contrast studies, ultrasound, and computed tomography (CT) all can be useful modalities in this area. Several examples of complications related specifically to the operative field in cholecystectomy are reviewed.     

悬雍垂腭咽成形术后主要并发症的观察及护理

目的探讨悬雍垂腭咽成形术后患者主要并发症的观察及有效处理措施,提高对其主要并发症的认识,以做到有效预防。方法回顾性分析总结2011年1月—2013年4月140例行悬雍垂腭咽成形术后患者的主要并发症观察及处理措施。结果 2例(1.43%)出现急性呼吸道梗阻,经严密观察、使用糖皮质激素、取正确卧位、有效清除呼吸道分泌物等呼吸道梗阻解除;5例(3.57%)出现出血,经过冷敷、及时用止血药物或双极电凝止血后出血停止;1例(0.71%)出现心脑血管病,立即行心脑复苏后改善。结论急性呼吸道梗阻、出血和心脑血管病等是阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行悬雍垂腭咽成形术后主要的并发症,术后及时进行病情观察、主动防范、发现问题采取有效处理措施、床旁常规备好抢救用物等,是确保术后达到改善通气、提高血氧饱和度、减少全身并发症目标的重要保证。     

Laparoscopic cholecystectomy: Imaging of complications and normal postoperative CT appearance

Six patients underwent imaging studies to evaluate complications related to laparoscopic cholecystectomy. In addition, computed tomography (CT) of the abdomen and pelvis was performed on six patients 3–5 days after uncomplicated laparoscopic cholecystectomy in order to further clarify the normal postoperative CT appearance in these patients. Complications included ureteral laceration with periureteric hematoma and ureteroperitoneal fistula, hepatic artery pseudoaneurysm, hepatic laceration, retained common bile duct stone, bile leak, and biloma of the abdominal wall. At 3–5 days following uncomplicated laparoscopic cholecystectomy, typical CT findings include fluid density in the gallbladder fossa, a very small amount of pelvic fluid, and small densities within the subcutaneous fat at the expected sites of trocar insertion.     

单纯甲状腺肿瘤患者术后并发症的观察及护理对策研究

目的 探究单纯甲状腺肿瘤患者术后并发症的发生情况以及护理对策.方法 选取248例进行手术治疗的单纯甲状腺肿瘤患者作为研究对象,观察并分析患者术后并发症的发生情况以及相对应的护理措施情况.结果 248例单纯甲状腺肿瘤患者术后有30例发生并发症,其中呼吸困难和窒息8例(清创止血、葡萄糖酸钙静推治疗有效8例,有效率为100％)、乳糜漏6例(开放引流治疗有效6例,有效率为100％)、甲状旁腺功能低下5例(葡萄糖酸钙静推治疗有效4例,有效率为80％)、术后出血8例(止血并严密观察生命体征治疗有效8例,有效率为100％)、喉返或喉上神经损伤3例(积极判断神经损伤并及时纠正治疗有效2例,有效率为66.7％).结论 对单纯甲状腺肿瘤患者术后密切观察病情及实施相对应的护理干预措施,可减少患者术后并发症的发生,提高治疗效果,提升患者满意度.     

Radiation-induced esophageal carcinoma

Radiation-induced carcinoma of the esophagus is rare and only 8 cases have been reported since 1957. This article presents 2 additional patients in whom esophageal carcinoma developed in segments previously exposed to large therapeutic doses of irradiation. The first patient had received 5,000 rads to her mediastinum and the second patient 3,200 rads to her neck region. The latent intervals were 11 years and 30 years, respectively.     

结直肠癌手术并发症及其影响因素分析

目的：探索结直肠癌患者手术并发症发生情况及其影响因素。方法选取2012年1月至2013年5月间在我院进行手术治疗的结直肠癌患者274例为研究对象,收集他们的临床资料,运用 SPSS 16.0统计软件对数据进行单因素和Logistic回归分析找出对结直肠癌手术并发症有影响的因素。结果结直肠癌患者手术并发症的总发生率为22.23%,肺部感染、伤口感染是最常见的并发症。单因素分析显示内科合并症（P＝0.000）、手术时间（P＝0.022）和Dukes分期（P＝0.012）会影响术后并发症发生。Logistic回归分析显示内科合并症（P＝0.001,OR＝5.213,95%CI 1.124～15.323）和手术时间（P＝0.002,OR＝16.231,95%CI 2.313～16.930）是术后并发症发生的危险因素。结论性别、年龄、烟酒史、肥胖情况、手术方法、麻醉方式、术中失血情况和中转手术并非结直肠癌患者术后并发症的危险因素,而治疗术前内科合并症,缩短手术时间,尽早治疗能够有效地减少术后并发症发生。     

Radiological detection of colonic dysplasia (precarcinoma) in chronic ulcerative colitis

Epithelial dysplasia occurring in long-standing ulcerative colitis is a precancerous lesion. Macroscopically it has a nodular or villous appearance or may be indistinguishable from the surrounding mucosa. An investigation into the radiological diagnosis of dysplasia, using in vivo and in vitro doublecontrast examinations with magnification radiographic studies, correlated with the histological analysis, has been made in four patients. Characteristic radiological abnormalities have been identified in the areas of the mucosa associated with histologically proven dysplasia. These appearances include nodularity and irregular areas with sharply angulated edges which may represent enlarged areae colonicae. The demonstration of these changes is an indication for endoscopie examination and biopsy of the suspicious area.     

Gastrointestinal leiomyosarcoma — Unusual sites: Esophagus,colon and porta hepatis

This paper is based on a retrospective analysis of the radiologic findings of 6 newly proven cases of primary gastrointestinal leiomyosarcomas located in unusual sites. The radiographic and angiographic features of esophageal, colonic, and porta hepatis leiomyosarcomas are described and illustrated. General background information together with a brief review of the literature regarding these lesions are provided. The difficulties encountered in the preoperative diagnosis are explained by the protean and nonspecific clinical and radiographic features of many of these tumors. In addition, although myomatous tumors of the liver and porta hepatis are angiographically hypervascular, similar tumors of the colon are slight to moderately vascular, and tumors of the esophagus are avascular.     

Radiologic demonstration of multiple foci of malignancy in the esophagus

Three patients, each with two synchronous esophageal carcinomas demonstrated radiologically, are presented. The importance of complete esophageal evaluation in patients with one obvious tumor of the esophagus is emphasized. Assessment of the full extent of disease in such cases directly affects treatment planning.     

床旁彩色及脉冲多普勒(双功能)超声评估原位肝移植术后并发症

目的 观察床旁彩色及脉冲多普勒(双功能)超声评估原位肝移植(OLT)术后并发症的价值。方法 回顾性分析65例接受OLT患者术后第1、3、7天床旁腹部双功能超声检查资料,评估肝脏实质回声及肝固有动脉及门静脉等血流束,测量门静脉峰值流速(PVPV)、肝动脉主干收缩期血流峰值流速(PSV)及血流阻力指数(RI)。根据腹部CT增强、CT血管成 像(CTA)、超声造影(CEUS)、临床干预(包括增强免疫抑制剂和二次移植手术)或病理结果,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估以OLT后第7天内超声所测PSV(PSV_第7天)及RI(RI_第7天)判断有无并发症的效能。结果 65例OLT后第1、3及7天,PVPV分别为71.00(45.50,96.50)、57.50(42.00,71.00)及50.00(33.00,66.00)cm/s,RI分别为0.68±0.16、0.69±0.17、0.66±0.13,各时间点间PVPV及RI差异均无统计学意义(H=5.475、P=0.065,F=0.964、P=0.501);PSV分别为63.00(44.50,89.00)、47.00(31.50,64.50)及50.00(38.25,64.75)cm/s,各时间点差异有统计学意义(H=7.313,P=0.026)。65例中,PSV正常46例、偏低(PSV＜25 cm/s) 1例、偏高(PSV＞100 cm/s)18例;RI正常18例、偏低(RI＜0.5)11例、偏高(RI＞0.7)36例。36例出现OLT后并发症。以PSV_第7天诊断OLT后并发症的AUC为0.561,RI_第7天为0.699,PSV_第7天联合RI_第7天为0.732,与单独RI_第7天差异无统计学意义(Z=0.290,P＞0.05)。结论 利用床旁双功能超声监测移植肝动脉主干血流信号及RI可有效评估OLT后并发症。     

Imaging of abdominal complications following cardiac surgery

Ten thousand seven hundred fifty-six patients underwent cardiac bypass surgery at the Mater Hospital national cardiac unit between September 1979 and April 1993. Of this group, 49 patients were identified who had developed postoperative gastrointestinal complications leading to 16 deaths. Twenty-five patients developed gastrointestinal hemorrhage, eight patients developed gallbladder disease, five patients developed phlegmonous pancreatitis, eight patients developed bowel perforations, and three patients developed intestinal pseudoobstruction. The particular radiological features that lead to diagnosis in each case are discussed and relevant literature is briefly reviewed.     

Localized saccular dilatation of the esophagus: An unusual cause of dysphagia

Two young women who had undergone resection of an esophageal enteric cyst subsequently developed saccular dilatation of the esophagus. The abnormality was localized to the site of previous surgery and caused dysphagia in both patients.     

Squamous cell carcinoma of the esophagus in patients with Acquired Immunodeficiency Syndrome

Two patients with Acquired Immunodeficiency Syndrome (AIDS) and infectious esophagitis developed squamous cell carcinoma of the esophagus. The clinical, radiographic, and endoscopic presentations in both cases were atypical. One patient developed a focal flat lesion that imitated segmental esophagitis, and the other patient developed a superficially spreading carcinoma that mimicked diffuse esophagitis. In the setting of AIDS, a changing radiographic or endoscopic mucosal pattern requires biopsy to exclude the possibility of a superimposed squamous cell carcinoma.     

脊柱手术后并发症的MR表现及鉴别诊断

目的：探讨脊柱手术后并发症的MR表现和MR在诊断及鉴别诊断中的临床应用价值。方法：对114例行MRI检查的脊柱手术后并发症患者的影像学资料进行回顾性分析，并与临床资料进行对照。结果：脊柱手术后主要并发症：椎管狭窄33例（硬膜外血肿或脓肿所致12例，硬膜外纤维化与瘢痕形成21例）；脊柱失稳43例；感染23例（术后椎旁软组织感染7例，椎间盘炎5例，椎体及附件感染4例，硬脊膜外脓肿3例，脊髓炎2例，脊蛛网膜炎2例）；其他28例（内固定失败12例，硬膜外血肿9例，脑脊液漏7例）。结论：MRI可明确显示脊柱手术后的各种并发症，在其诊断和鉴别诊断中有独特价值。