Recent advances in the diagnosis and treatment of pheochromocytoma

Pheochromocytoma (PHEO) is considered to be a rare cause of hypertension. However, if left untreated, PHEOs may lead to fatal hypertensive crises during anesthesia and other stresses. The diagnosis of PHEO is therefore extremely important. A 24-hour blood pressure (BP) pattern per se might be of some diagnostic value due to frequently observed higher BP variability as well as an attenuated night-time BP decrease. So far, germline mutations in five genes have been identified to be responsible for familial PHEOs: the von Hippel-Lindau gene, which causes von Hippel-Lindau syndrome, the RET gene leading to multiple endocrine neoplasia type 2, the neurofibromatosis type 1 gene, which is associated with von Recklinghausen's disease and the genes encoding the B and D subunits of mitochondrial succinate dehydrogenase (SDHB, SDHD), which are associated with familial paragangliomas and PHEOs. Genetic analysis should be offered to those patients with confirmed PHEO who are 50 years old or younger. Plasma-free metanephrines or urinary fractionated metanephrines seem to have higher diagnostic values compared to plasma or urinary catecholamines for the biochemical diagnosis of PHEO. Imaging with (123)I-metaiodobenzylguanidine or (18)F-fluorodopamine PET, if available, are in addition to CT/MRI useful for the detection of multifocal/extra-adrenal forms. Appropriate pharmacologic treatment with subsequent laparoscopic extirpation of PHEO is usually successful in benign forms. There is, however, no convincingly effective mode of treatment in malignant PHEOs.     

Recent advances in the diagnosis and treatment of primary hyperparathyroidism

The incidence of hyperparathyroidism (pHPT) in Japan is lower than that in Western countries. The frequency of diagnosis, however, has increased due to the recent introduction of automated multichannel analysis of serum chemistry in routine screening and to the longevity of the Japanese population. The goal of surgical treatment for primary pHPT is restoration of calcium homeostasis by removal of hyperfunctioning parathyroid glands. Surgery is successful in over 95% of cases. The advent of the sestamibi scan in the early 1990s changed the management of pHPT. The trend has been toward less invasive procedures including endoscopic parathyroidectomy using sophisticated preoperative imaging tests, a hand-held gamma probe, and intraoperative rapid measurement of parathyroid hormone levels. We review recent advances in the diagnosis and treatment of pHPT.     

Recent advances in the diagnosis and treatment of colorectal cancers

We review recent developments in the diagnosis and treatment of colorectal cancer. In diagnosis, the detection of the APC gene mutation in stool samples has had a strong impact because of its practical usage for mass screening. Several reports have indicated that the molecular detection of a very small number of cancer cells in the peripheral blood, bone marrow, or lymph nodes yields adequate information on recurrent disease. Several new markers were reported as a significant indicators of cancer development, invasion, or metastasis. In treatment, determination of microsatellite instability may be useful to select good candidates for 5-fluorouracil-based chemotherapy. New molecular targets have been reported, including epidermal growth factor receptor inhibitor, matrix metalloproteinase inhibitors, etc. Gene therapy with p53 or FHIT had undergone successful clinical trials. Tumor-specific immunotherapy with dendritic cell vaccination has also been achieved. In conclusion, many efforts to overcome colorectal cancer will soon open new therapeutic windows.     

非酒精性脂肪性肝炎的诊断和治疗进展

非酒精性脂肪肝疾病(nonalcoholic fatty liver disease,NAFLD)以肝细胞中脂肪过多积累为标志,包括非酒精性脂肪肝(nonalcoholic fatty liver,NAFL)和非酒精性脂肪性肝炎(nonalcohol-ic steatohepatitis,NASH),其中NASH可能会...     

尿脓毒症的诊治进展

脓毒症是临床工作中常见的危重疾病之一,病死率高达20％ ～42％[].泌尿系感染引起的严重脓毒症约占脓毒症总数的5％～7％[2-3],医院获得性感染中泌尿系感染的数量约占40％[4].近年来,随着对脓毒症这一疾病诊断和治疗水平的不断提高,病死率有所下降[1,5],但是脓毒症及尿脓毒症的发病率逐年上升,病死人数较前并没有下降,有文献报道美国每年死于严重感染性休克的患者约215 000人,其中感染源位于泌尿生殖系统的占9.1％[6 ].本文针对尿脓毒症的病因、诊断及治疗做一综述.     

代谢组学在男性不育诊疗中的应用研究

代谢组学是研究生物体内源性小分子代谢物的新兴学科。代谢组学通过对体液、细胞及组织的研究,在男性不育疗效评价中发挥着重要作用。这种高信息量、无创、快速的研究技术进入临床应用将成为未来的发展趋势。本文介绍了代谢组学及其分析技术和数据处理过程,并介绍了代谢组学对男性不育有害物质暴露、生物标志物和药物治疗等的研究,对其在男性不育病因探究和诊疗中的最新研究进展进行了综述,最后提出代谢组学在男性生殖领域的研究前景。     

Recent advances in the diagnosis and treatment of pheochromocytoma in children

BACKGROUND: The purpose of this study was to analyze the effects of changes in the diagnosis and treatment of pheochromocytoma in a pediatric population. METHODS: We reviewed the medical records of all children who had resection of pheochromocytoma or paraganglioma at a major children's hospital since 1968. RESULTS: Fifteen children underwent surgery at 11.9 +/- 4.2 years of age. Presenting symptoms included headache, hypertension, and sweating. Three children had a mutation of the succinate dehydrogenase enzyme, and 1 child had nonsyndromic, familial pheochromocytoma. The most sensitive diagnostic modalities included 24-hour urinary and plasma norepinephrine and 24-hour urinary total metanephrines, magnetic resonance imaging, and 123I-meta-iodobenzylguanidine scintigraphy. Laparoscopic cortical-sparing adrenalectomy was performed in 3 patients with von Hippel-Lindau disease. Compared with those with open procedures (n = 7), patients who had laparoscopic resection (n = 5) had a statistically shorter hospital length of stay, and time to eating ambulation. CONCLUSIONS: The addition of 123I-meta-iodobenzylguanidine scanning, genetic testing, and laparoscopic surgery has changed the diagnosis and treatment of pheochromocytoma in children. Laparoscopic cortical-sparing adrenalectomy can be accomplished safely and is the preferred treatment for children at risk for multifocal disease.     

胰腺癌诊断治疗中的几个热点问题浅谈

胰腺癌是消化道最难治疗的恶性肿瘤之一.由于其解剖位置特点和生物学特性,即使行根治性切除,5年生存率也仅为10％～20％.目前,在胰腺癌的诊断和治疗中仍有许多问题有待解决.该文对胰腺癌可切除性的判断、组织学诊断、根治切除、多学科综合治疗等热点问题进行了论述,希望能对提高国内胰腺癌的诊治水平有所帮助.     

自身免疫性胰腺炎的诊治现状与进展

自身免疫性胰腺炎从1995年其概念被提出,作为慢性胰腺炎的一种,逐渐受到重视,具有自身免疫性的特点.尽管,近年来国外报道较多,其诊断标准并不统一,不易与胰腺癌鉴别;但结果显示,激素治疗效果显著.     

Modern concepts in the diagnosis and treatment of male infertility

The use of modern techniques to manipulate sperm has assisted many couples in their effort to achieve pregnancy. Use of the techniques is dependent upon adequate and complete diagnostic data to determine if the techniques would be beneficial for a particular couple. The participation of a urologist in these techniques can take many forms but should be active to assure the best treatment for the male patient with fertility difficulties and to prepare the sperm with the available techniques prior to use for insemination or in-vitro fertilization. The future looks exciting and is sure to bring many more new developments that will benefit couples with fertility problems.     

骨关节炎的诊治与研究进展

骨关节炎(osteoarthritis,OA)是影响人类健康最常见的关节疾患之一,人群发病率约为2%～6%,是导致50岁以上人群功能残疾、造成经济损失和影响社会发展的主要疾病之一.骨关节炎具有临床、病理和影像学多重定义;在其疾病发生与发展过程中,在全身因素和局部因素综合作用下,关节软骨发生生化、结构和代谢改变,最终出现关节软骨软化、破溃和局部剥脱以及关节边缘骨与软骨赘生物形成等病理改变,并引起相应临床症状;骨关节炎相关的滑膜炎症是软骨基质降解产物引起的继发性改变,滑膜炎性病变在骨关节炎的发生中不是旁观者,而是关节结构破坏的参与者,促进了骨关节炎的病程进展.骨关节炎的治疗目标是控制疼痛、改善关节功能和生活质量,尽可能避免治疗的毒副作用.目前,骨关节炎缺乏治愈的手段.但是,针对患者设计的个体化治疗方案可以减轻疼痛、保持或改善关节活动度,减缓关节功能的受损.应重视对患者的教育和康复治疗,特异性COX-Ⅱ抑制剂减少了胃肠道副反应事件的发生.当内科保守治疗无效,而日常活动进行性受限时,应该考虑关节镜清理、截骨术和关节置换手术等外科治疗.软骨移植、氨基葡萄糖、针对炎性因子或细胞内与炎症相关的信号分子的生物治疗手段为骨关节炎的治疗开辟了新的研究方向.     

骨筋膜室综合征诊断与治疗的研究进展

【摘要】〓骨筋膜室综合征(OCS)是指由各种原因造成的肢体创伤导致筋膜室内压力(ICP)升高,阻断筋膜室内组织微循环而引发的一系列症状和体征。目前其病理、病因已有明确的认识,即缺血4小时以上就可造成不可逆的损伤,早期准确诊断及选择适当的治疗方案就尤为重要。但目前临床上对该病诊断的准确性尚有所不足,治疗方案的选择仍有不同的见解。本文对OCS的早期诊断和动态监测以及治疗方法进行了回顾分析,旨在提高该病诊断的准确性,以及为该病的最佳处理方式提供指导。     

嗜酸性膀胱炎的研究进展

嗜酸性膀胱炎是一种病因未明的良性罕见病。临床表现以尿频、排尿困难、血尿、耻骨上区疼痛、尿潴留等为主,临床诊断困难,易与膀胱肿瘤等疾病相混淆,确诊依靠病理。治疗以抗炎、抗过敏为主,必要时行膀胱灌注药物及手术。     

腭咽闭合不全诊治的最新进展

腭咽闭合不全(VPI)患者的诊断和治疗是整形外科及耳鼻咽喉科的范围,对此疾病的诊断方法也在不断进步。一般来说,需要语音病理学家的评估,同时结合鼻音的客观测量。腭咽肌环的闭合能力可以被X线照影以及鼻咽纤维镜直接诊断,而且鼻咽中腭咽闭合的位置、闭合不全的位置及大小可以     

Crouzon综合征的诊断及治疗进展

Crouzon综合征是颅缝过早闭合导致的一种颅面畸形,以颅缝早闭、中面部发育不良及双侧突眼等为主要表现,可引起颅内高压、失明等不良并发症。随着诊断技术及外科治疗的发展,使得Crouzon综合征的诊断治疗得到了长足进步。本文回顾了Crouzon综合征的诊断及外科治疗进展,现综述如下。     

Developments and advances in the diagnosis and treatment of injuries to the tarsometatarsal joint

Continued research and clinical advances have allowed clinicians to diagnose injuries of the tarsometatarsal joint earlier and with greater precision than in previous eras and have promoted refinements of the surgical procedures used in their treatment. For patients with such injuries, these advances should result in improved function and a substantial decrease in morbidity.     

Periampullary tumours: advances in diagnosis and surgical treatment.

Forty-five carcinomas of the region of the ampulla of Vater were resected at the Toronto General Hospital during a 16-year period. In 26 the presenting symptom was pain and in 32 it was jaundice. The most useful means of investigation was endoscopic retrograde cholangiopancreatography. Angiography was of value in determining resectability prior to operation, and percutaneous aspiration biopsy allowed a preoperative diagnosis in the case of large pancreatic tumours. In 39 patients who had a Whipple procedure the operative mortality was 8%. Total pancreatectomy performed in two patients and local excision of ampullary carcinoma in four patients were attended by no operative deaths. Long-term survival was best in patients with ampullary carcinomas and worst in those with pancreatic cancer.