腹腔镜结合米非司酮治疗子宫内膜异位症疗效分析

采用腹腔镜手术结合术后服用米非司酮治疗子宫内膜异位症105例，随访92例(88％)，时间6～25个月，86例患临床症状得以缓解或消失，35例合并不孕症患中16例得以受孕生育，2例复发(1.9％)，取得了较好的临床效果。     

Oligodendrocytic Gliomatosis Cerebri

We describe a very unusual case of gliomatosis cerebri (GC) with oligodendrocytic differentiation. A 65-year-old man presented with a convulsive seizure. Magnetic resonance (MR) documented diffuse enlargement of cerebral hemispheres, brainstem, and right cerebellar hemisphere. After admission, the patient manifested a progressive deterioration of his neurological condition. A right temporal craniotomy and temporal lobectomy were performed to obtain brain decompression and diagnosis. Pathological findings were those of a GC consisting of neoplastic oligodendrocytes. Oligodendrocytic GC is a very rare pathological condition. Diagnosis of GC is usually made at autopsy. Our case confirms that diagnosis by a combination of MR imaging and brain biopsy.     

Gliomatosis Cerebri in a Dog

Gliomatosis cerebri is a rare tumourous disease of the central nervous system consisting of glial cells characterized by diffuse widespread infiltration and preservation of preformed brain structures. This report describes a case of gliomatosis cerebri in a 9‐year‐old, male, flat‐coated retriever dog with central nervous symptoms. Magnetic resonance imaging of the brain demonstrated ill‐defined hyperintense zones of paramedian white matter within the right cerebral hemisphere, brainstem and cerebellum. Histological examination showed a proliferation of tumour cells in the brain structures mentioned. Glial fibrillary acidic protein‐immunohistochemistry revealed a lot of fibres positively stained. Based on these findings, the alteration was diagnosed as gliomatosis cerebri.     

Gliomatosis cerebri. Report of two cases

Gliomatosis cerebri is a rare tumor of the central nervous system, and here we report two cases of this tumor. Case 1: A 41-year-old female was admitted to our department for evaluation of activity loss and mental changes. MR imaging revealed a high intensity symmetrical lesion in the bilateral frontal and temporal regions, thalamus and midbrain on FLAIR images. The patient had no neurological deficits and no abnormal findings in clinical laboratory data, including data for the cerebral spinal fluid. A specimen obtained by open biopsy revealed widespread infiltration of neuronal structures by small astrocytic cells, although without destruction of the neuronal structures. The patient was diagnosed with gliomatosis cerebri, and surgery and whole brain radiation at 44Gy were performed. The MRI lesion showed some shrinkage 20 months after surgery, and the KPS score was 90, the same as that before admission. Case 2: A 56-year-old male was admitted for numbness of the face and extremities. MR imaging revealed a high intensity lesion in the bilateral thalamus and a ringed enhanced lesion in the right thalamus. A specimen obtained by open biopsy revealed anaplastic oligodendroglioma, which was diagnosed as gliomatosis cerebri. Radiation at 54Gy, chemotherapy (ACNU, vincristine) and gamma-knife surgery were performed, and two months later MR imaging showed that the tumor (including the ringed enhanced lesion) had shrunk markedly. His KPS was 90 at 13 months after onset. These cases suggest that radiation therapy is effective for gliomatosis cerebri.     

Gliomatosis cerebri: a review of 22 cases

OBJECTIVE: Gliomatosis cerebri is an enigmatic diffuse brain neoplasm whose prognosis is grim. We reviewed data for patients with gliomatosis who were treated at the University of California, San Francisco, during a 10-year period. Our focus was on presentation, radiological and pathological features, and outcomes. METHODS: We reviewed hospital and clinic records and magnetic resonance imaging scans for 22 patients with gliomatosis. The diagnosis was based on magnetic resonance imaging findings and tissue confirmation for all patients. Seven patients also underwent magnetic resonance spectroscopy. Eleven patients were male (50%), and the median age at presentation was 49 years (range, 7-79 yr). RESULTS: Kaplan-Meier analysis demonstrated median lengths of survival as follows: no treatment, 1 month (n = 4); radiotherapy alone, 28 months (95% confidence interval, 5-51 mo; n = 13); radiotherapy followed by chemotherapy, two patients, alive at 28 and 104 months; radiotherapy and chemotherapy simultaneously, three patients, one alive at 18 months and the others dead at 7 and 9 months. There was no significant difference between radiotherapy alone and radiotherapy combined with chemotherapy (P = 0.69). Karnofsky Performance Scale scores of >/=70 and grade were both significantly related to length of survival in univariate analyses (P < 0.05); these correlations were confirmed in the multivariate analysis, although the small numbers of patients and deaths precluded reliable interpretation. CONCLUSION: Although the small number of patients in our study and its retrospective nature preclude definitive conclusions regarding the utility of treatment, our findings suggest that biopsies are useful not only for diagnosis but also for prediction of the length of survival.     

Endometriosis

On the basis of two recently treated cases of endometriosis, the main aspects of this unusual pathology are examined; in particular its aetiopathogenesis, clinical picture and treatment still provide reasons of uncertainty. On the basis of an albeit limited experience, stress is laid on the importance of radical surgery, the only way to resolve the situation. Medical or conservative surgical measures are left to the early stages of the disease.     

Endometriosis

Endometriosis is related to retrograde menstruation or coelomic metaplasia and depends on the presence of estrogen. It is a consequence of menstruation into an area that has no outlet for menstrual blood. As a result, antigenic substances are released, causing an inflammatory response and the formation of prostaglandins. Subsequent inflammatory repair distorts pelvic anatomy and the prostaglandins affect ovarian, tubal and uterine function. Symptoms are not specific, so definitive diagnosis depends on laparoscopy or laparotomy for confirmation. Medical therapy is aimed at reducing the estrogen on which the endometriotic lesions depend. Danazol, a testosterone derivative, does this by interfering with ovarian follicular development, and often results in both symptomatic and objective improvement. When therapy is withdrawn, the renewed estrogen stimulus may cause the lesions to recur. Conservative surgical therapy (the excision of endometriotic nodules and the restoration of pelvic anatomy while leaving a reproductive potential) is equally successful. Radical surgery (abdominal hysterectomy and bilateral salpingo-oophorectomy) is definitive, removing both the stimulus for endometriotic growth and the source of renewal.     

Gliomatosis cerebri: Bioptical approach and neuropathological verification

Summary Gliomatosis cerebri is rarely encountered and itsintra vitam diagnosis has remained difficult. We present biopsy and autopsy findings in three cases that are representative of diffuse glioma, gliomatosis cerebri and diffuse glioblastosis, a modification of the subclassification proposed by Zülch. Stereotactic biopsy in conjunction with nuclear magnetic resonance tomography (MRT) is recommended as the diagnostic procedure in suspected cases. Immunohistochemical examination with a panel of neuroectodermal markers is helpful in the differential diagnosis but has to take into account that reactive astrocytes may be closely intermingled with the neoplastic glial cells.     

Pelvic trauma management within the UK: a reflection of a failing trauma service

During the past 2-3 years it has become increasingly difficult for specialist pelvic centres to provide appropriate treatment for patients. Recent data from 3 such units has highlighted unacceptable delays from referral to operation. This article presents this data, analyses the reasons for the delays and the consequences. The focus on waiting list targets is deflecting resources away from specialist trauma services (including pelvic units) and has resulted in serious interruptions in treatment. Urgent action is required to prevent the management of these patients being compromised.     

Ovarian Teratoma with Gliomatosis Peritonei: Report of Two Cases

(Received for publication on June 3, 1996; accepted on Jan. 7, 1997)     

输尿管子宫内膜异位症（附6例报告）

目的:总结输尿管子宫内膜异位症的临床,病理特点及采用不同手术方法治疗的效果.方法:回顾分析6例输尿管子宫内膜异位症患者的临床资料、术后随访资料,并对这些结果进行对比分析.结果:6例患者均为单侧发病、均为下1/3段,3例术前病理确诊,行病变段切除、输尿管膀胱再植术,术后随访1～5年,均无复发梗阻;另外3例术前未确诊,行病变段冷刀内切开+双重双J管内引流2～3个月,拔管后随访过程中,1例失访,另外2例分别于6和11个月复发梗阻.改为病变段切除、输尿管膀胱再植术,再随访1～3年,未发现复发梗阻.6例术后2周始均结合药物内分泌治疗3～6个月,其中3例口服丹那唑0.2 g Bid,3例皮下注射康士得3.6mg 1次/月.结论:输尿管镜下冷刀内切开虽然创伤较小,但不能完全去除异位的子宫内膜,梗阻复发率较高,故临床上以采用病变段切除、输尿管膀胱再植术,结合内分泌治疗为妥.     

Pelvic and acetabular surgery within Europe: the need for the co-ordination of treatment concepts

Pelvic and acetabular injuries are rare and represent the tip of the trauma iceberg. They often present with other associated injuries. Their management can pose difficulties even to the most experienced trauma surgeons and well-developed trauma systems. Despite the advancements made after the 1960s due to Judet and Letournel's contributions, the pelvic and acetabular sub-specialty has had difficulty in consolidating experience and developing realistic treatment protocols. By means of sharing ideas and results, "learning curves" of individuals and nations could be shortened. As a result, better health quality and advanced medical facilities for our future patients may be anticipated. In this article we examine the current problems affecting the provision of a high quality pelvic and acetabular service and analyse the needs for the co-ordination of treatment concepts within the European Landscape.