肾上腺髓质脂肪瘤的超声诊断

目的：探讨肾上腺髓质脂肪瘤的超声特点及其诊断价值。方法：回顾性分析23例经手术与病理诊断证实为肾上腺髓质脂肪瘤患者的超声表现及临床资料,并与CT检查结果对比,分析其超声声像图特点及超声诊断的可靠性和临床价值。结果：23例肾上腺髓质脂肪瘤中,超声表现为均质型强回声者17例,强回声区内分布低回声者5例,漏诊1例。彩色多普勒超声检查上述病灶内均未见明确血流信号。超声和CT诊断肾上腺占位性良性肿瘤的敏感性分别为95.7%（22/23）和100%（20/20）,诊断肾上腺髓质脂肪瘤的敏感性分别为26.1%（6/23）和80.0%（16/20）,两者比较差异有统计学意义（P〈0.05）。结论：超声对肾上腺髓质脂肪瘤的诊断有重要价值,可作为肾上腺髓质脂肪瘤的筛查和随访观察的可靠方法。     

A case of bilateral adrenal myelolipoma

We reported a case of bilateral adrenal myelolipoma. Low height, obesity and and elevation of 17-KS were found in this case. Tumors were hypovascular adrenal masses with low attenuation numbers on CT. MRI was useful in demonstrating the relation of tumors to adjacent organs. It should be considered that, although very rare, bilateral myelolipoma is possible.     

A case of lung myelolipomatosis in a patient with bronchial carcinoid.

Myelolipomas are very rare benign tumours composed of an admixture of mature adipose tissue and normal haematopoietic cells. Although they are most commonly found in the adrenal glands, extra-adrenal myelolipomas are documented. We described a case of myelolipoma arising in the lung in a 52-year-old man. The lesion was found incidentally in association with a carcinoid. To our knowledge, this is the second instance of this neoplasm presenting as a lung lesion, and the first case associated with bronchial carcinoid. Pathogenesis and aetiology of myelolipomas are referred to in this paper with special regard to the clinical and pathological findings.     

螺旋CT对肾上腺髓样脂肪瘤的诊断价值探讨

目的探讨螺旋cT对肾上腺髓样脂肪瘤的诊断价值及鉴别诊断。方法对经手术病例证实的12例肾上腺髓样脂肪瘤的临床、病理及cT表现进行回顾性分析。结果12例肾上腺髓样脂肪瘤cT表现为含脂肪成分的混杂密度肿块,边缘光滑,增强扫描脂肪影无强化,软组织密度影有轻度至中度强化,其中含脂肪密度影具有明显cT特征性。术前cT诊断与术后病理诊断完全相符。结论螺旋cT扫描对肾上腺髓样脂肪瘤定位和定性诊断具有重要价值,可作为目前诊断该病的首选方法。     

肾上腺骨髓脂肪瘤的CT诊断

目的：探讨肾上腺骨髓脂肪瘤的CT诊断价值。方法：对7例经手术病理证实的肾上腺骨髓脂肪瘤的CT表现进行回顾性分析。结果：7例肾上腺骨髓脂肪瘤行B超筛查后，5例做了CT平扫和增强，表现为含不同比例脂肪和骨髓组织的圆形或类圆形混杂密度肿块，边界清晰，增强扫描骨髓组织轻度强化，脂肪组织不强化；另2例仅做了CT平扫。CT诊断7例均与术后病理诊断一致。结论：肾上腺骨髓脂肪瘤有特征性CT表现，CT可以明确诊断。     

超声在肾上腺占位性病变中的诊断价值

目的:探讨超声在肾上腺占位性病变中的诊断价值及其超声影像学特点。方法:回顾分析12例肾上腺占位的二维及彩色多普勒超声的声像图特点。结果:12例病例中有6例为嗜铬细胞瘤,2例为肾上腺囊肿,2例为肾上腺转移癌,1例为无功能皮质腺瘤,1例为髓样脂肪瘤。结论:结合病史资料,根据不同的超声声像图表现,可提高对于肾上腺占位性病变的诊断。     

MSCT 薄层增强扫描在肾上腺肿瘤诊断中的价值简

目的：根据肾上腺肿瘤的CT表现与病理对照分析,评价MSCT薄层增强扫描对肾上腺肿瘤的诊断和鉴别诊断价值,提高对肾上腺肿瘤的诊断水平。方法：回顾性分析27例经手术病理证实的各类肾上腺肿瘤的CT表现及病理组织学类型。结果：皮质腺瘤10例,皮质腺癌1例,嗜铬细胞瘤7例,囊肿2例,髓样脂肪瘤4例,转移癌3例。结论：肾上腺肿瘤CT表现有一定的特征性,MSCT薄层扫描能提高其定位诊断准确率,肿瘤增强特点与病理结构相关,认真分析,结合临床及生化检查,可对其作出定性诊断。     

后腹腔镜肾上腺肿瘤切除术35例体会

目的:探讨后腹腔镜肾上腺肿瘤切除术的临床治疗效果。方法:回顾性分析我院2007年1月至2011年6月开展的35例后腹腔镜肾上腺肿瘤切除术患者的临床资料,其中皮质腺瘤25例,嗜铬细胞瘤5例,肾上腺髓样脂肪瘤3例,肾上腺囊肿2例。结果:34例手术成功,1例中转开放手术。手术时间50-130min,平均85min;失血量20-250mL,平均50ml;术后住院时间3-8天,平均4.5天。所有患者术中、术后均未输血,无严重并发症发生。结论:后腹腔镜下手术切除肾上腺肿瘤是一种微创、安全、有效的手术方式,具有出血少、恢复快、住院时间短等优点。     

多层螺旋CT后处理技术在肾上腺肿瘤及肿瘤样病变中的应用价值

目的：探讨多层螺旋CT（MSCT）在肾上腺肿瘤及肿瘤样病变中的诊断价值及其临床意义。方法：收集经临床保守治疗或手术病理证实的肾上腺肿瘤及肿瘤样病变24例,进行多层螺旋CT检查及三维重建,后处理技术包括薄层重建、多平面重组（MPR）、容积重组（VR）及最大密度投影（MIP）,并进行回顾性分析。结果：24例肾上腺占位病变中,肾上腺增生7例,腺瘤6例,髓样脂肪瘤2例,肾上腺囊肿3例,嗜铬细胞瘤1例,肾上腺转移癌5例。肾上腺良性病变直径多小于3 cm,边界清晰。三维重建图像能清晰显示肾上腺肿瘤及肿瘤样病变的细微结构并能比较准确地对肾上腺肿瘤及肿瘤样病变作出诊断。结论：多层螺旋CT图像质量好,对肾上腺肿瘤及肿瘤样病变的综合判断能力较强,具有较好的应用价值。     

Extrapulmonary tuberculosis. A review.

The increase in cases of tuberculosis that has occurred with the increasing number of individuals infected with the human immunodeficiency virus (HIV) has focused attention on the problems in diagnosing and treating tuberculosis. While it is primarily considered a pulmonary disease, tuberculosis has the potential to infect almost every organ system via lymphohematogenous dissemination during the initial pulmonary infection. Since 1984 the incidence of extrapulmonary tuberculosis has increased at an even faster rate than that of pulmonary tuberculosis. Extrapulmonary tuberculosis is considered a diagnostic criterion in the case definition of the acquired immunodeficiency syndrome. Immunocompromised individuals, such as patients with HIV, are at increased risk for extrapulmonary tuberculosis. The clinical manifestations are often nonspecific and insidious, and diagnosis may be delayed for years. Cases of miliary and meningeal tuberculosis are an exception, and they often constitute medical emergencies. Tuberculosis skin tests should be performed on all individuals suspected of having tuberculosis, but a negative test result does not exclude the diagnosis. Chest roentgenograms will often show signs of old or active pulmonary tuberculosis. Microscopic examination and culture of infected body fluids and/or tissue are necessary for definitive diagnosis. Treatment is with standard antituberculous medications. Short-course therapy (6 or 9 months) is probably adequate in most patients with extrapulmonary tuberculosis, but patients with human immunodeficiency viral infection need longer treatment. Extrapulmonary tuberculosis is a persistent problem in the United States and will become more prevalent as the number of patients with HIV increases. A high index of suspicion is needed to diagnose and treat extrapulmonary tuberculosis in a timely and health-preserving manner.     

Heat illness. III. Acclimatization.

In this third paper on heat illness, the position of acclimatization in prevention of heat illness is reviewed. Both short and long-term acclimatization are considered, the former in more detail with discussion of present knowledge of the differences arising from artificial and natural acclimatization, the effects of training, water intake and increasing salt intake, and climatic chamber and vapour-barrier suit acclimatization. The possibility of the development of a safe drug to accelerate acclimatization is considered remote. The effects of age and acclimatization in the healthy and unhealthy elderly and the very young are reviewed briefly as is also the possibility that air conditioning may have an adverse effect on acclimatization.     

Networks help assure survival. Interview by Donald E.L. Johnson

Health care is increasingly a regional business rather than a national one, so hospitals should join or form local networks of providers, insurers and managed care entities, says Gary A. Mecklenburg, president and CEO of Northwestern Memorial Hospital, Chicago, in an interview with Health Care Strategic Management's Donald E.L. Johnson. Institutions that don't participate in the regionalization of health care could be left out. Mecklenburg, who is also president and CEO of the Northwestern Healthcare Network, expects hospital networks, insurers and managed care providers to form more exclusive or limited relationships. Northwestern Memorial is a 723-bed hospital and academic institution with a medical staff of 1,000 physicians. The Northwestern Healthcare Network is an organization formed in 1990 which brings together Northwestern Memorial, Children's Memorial, Evanston, Glenbrook and Highland Park Hospitals under a holding company.     

Industrial effluent B.O.D. Quanta and expected causes.

The biological oxygen demand (B.O.D.) is an important parameter for the measurement of organic pollutants in waste water. The present paper deals with the various causes which may be responsible for B.O.D. variations in waste water of different types of industrial effluents.     

Nutrition in Space: Evidence from the U.S. and the U.S.S.R.

Space flight exposes humans to a hostile, stressful environment as well as to the weightlessness associated with microgravity. The stresses of space travel affect nutritional balance, as evidenced by interrelated changes in body composition, energy utilization, and endocrine function. The limited data gathered thus far suggest that space flight incurs acute decreases in fluid mass and chronic, ongoing changes in muscle and bone mass. Concurrent with these changes is an increase in energy used per unit body mass. Other preliminary data suggest that bed rest and space flight may incur increased sensitivity to insulin. Further research is needed to determine the human energy and protein requirements for space, as well as a means of quantifying changes in body composition during extended-duration space flight.     

Systems require visionaries. Interview by Donald E. L. Johnson

If metropolitan and regional multihospital systems are to be an integral part of the future of health care, what will separate the successful systems from the unsuccessful ones? How do administrators bring hospital medical staff members together in a cohesive, cooperative team? In the following interview with Health Care Strategic Management publisher, Donald E. L. Johnson, Don L. Arnwine, former hospital chief operating officer and current president of Arnwine Associates, discusses the elements of a successful multihospital system. Arnwine Associates is an Irving, Texas-based consulting firm.     

Building a regional medical center. Interview by Donald E.L. Johnson

Allen P. Fletcher is president of a 372-bed community hospital that is between Atlanta and Birmingham and loses patients to hospitals in those cities more frequently than he likes. Northeast Alabama Regional Medical Center, Anniston, Alabama, runs an average daily census of about 165 patients and many of its 100 active physicians are so busy that they have waiting lists. Fletcher has been president of Northeast for six years. He holds an MHA from Georgia State University. In an interview with Donald E.L. Johnson, editor and publisher of Health Care Strategic Management, Fletcher talks about the small window of opportunity he sees for secondary hospitals.     

N.Y. hospital moves in on opportunity

A financially struggling hospital in New York's Harlem section is turning financial distress into an opportunity for economic recovery with the help of private grants, state rate relief and an innovative capital financing program. North General Hospital will move into a new, $65 million facility in December--five months ahead of schedule and $9 million under budget.     

Immunoreactivity in pulmonary echinococcosis. 2. Evaluation of antibody response.

The part played by certain factors in determining the antibody response in pulmonary echinococcosis has been studied. Five immunodiagnostic procedures were used—complement fixation, latex agglutination, bentonite flocculation, passive haemagglutination, and intradermal tests—and parasitological and pathological examinations were carried out. The number of hydatid cysts had only a small influence on the qualitative nature of the immune response while the quantitative effect was considerable. The immune response did not vary significantly in relation to the size of hydatid cysts but it was affected by changes within the cysts and the surrounding lung tissue. In patients with cysts full of clear hydatid fluid the proportions with negative results and relatively low antibody titres were highest. In these patients the size of hydatid cyst appeared to be significant—the smaller the size, the lower the antibody level. The immune response is weak or completely absent when the hydatid cyst has a thick fibrous capsule. When suppurative changes are present in the hydatid fluid and/or in the fibrous capsule, and when there is inflammatory involvement of the surrounding lung tissue an easily detectable immune response may be seen at an early stage, sometimes even with a high antibody level, but later it usually decreases and may disappear completely. A hypothesis for the explanation of immunological reactivity in pulmonary hydatid disease is discussed.     

Obesity and hypertension. Hemodynamic aspects.

Elevated arterial pressure in patients with obesity-hypertension is associated with an increased cardiac output and total peripheral resistance. The elevated output is related to expanded intravascular volume that increases cardiopulmonary volume, venous return, and left ventricular preload; the elevated pressure and total peripheral resistance increase afterload. This dual ventricular overload promotes a dimorphic, concentric, and eccentric hypertrophy in response to the volume and pressure overload. Increased myocardial oxygen demand results from the elevated tension in the left ventricular wall, reflecting its increased diameter and pressure, and provides physiologic rationale for the greater potential of coronary arterial insufficiency and cardiac failure. There are greater renal blood flow and lower renal vascular resistance in patients with obesity-hypertension at any level of arterial pressure. This may be offset by an increased renal filtration fraction that may favor protein deposition and glomerulosclerosis, and predisposition of obese patients for diabetes may aggravate this problem. With weight reduction, these hemodynamic derangements may be reversed: intravascular volume contracts, cardiac output decreases, and arterial pressure falls.