Clinical study of prostate cancer: statistical analysis of 107 cases in the past 12 years

One hundred and seven patients with prostate cancer were treated at Mie University Hospital during the past 12 years between 1988 and 1999. They were between 53 and 83 years old, with an average age of 70.8 years old. The clinical stage was defined as A, B, C and D in 3 (2.8%), 19 (17.8%), 50 (46.7%) and 35 (32.7%) patients, respectively. At initial diagnosis, the tumor was well, moderately and poorly differentiated adenocarcinoma in 26 (24.3%), 47 (43.9%) and 34 (31.8%) patients, respectively. The median follow-up period was 52.3 months. The overall 1, 3 and 5-year survival rates were 98.0%, 86.8% and 75.2%, respectively. The 5-year survival rates for stage A, B, C and D were 100%, 93.8%, 82.1% and 56.9%, respectively. A significant difference (p = 0.017) in 5-year survival rate was noted between stage C and D. The 5-year survival rate was 100% for well differentiated, 78.0% for moderately differentiated, and 53.2% for poorly differentiated adenocarcinoma. A significant difference (p = 0.0016) in the 5-year survival rate was noted between well differentiated and poorly differentiated adenocarcinoma. According to the therapy, the 5-year survival rate in stage C was 86.2% for the radical prostatectomy group and 84.0% for the endocrine therapy group. There was no significant difference between these 2 treatment groups. Endocrine therapies, classified into maximum androgen blockade (MAB) and endocrine therapy other than MAB were performed for stage D as an initial therapy. Although the prognosis in the patients treated with MAB was better than that with other endocrine therapies, there was no significant difference between these 2 endocrine treatment groups.     

107例慢性淋巴细胞性甲状腺炎并甲状腺腺瘤临床分析

目的：总结慢性淋巴细胞性甲状腺炎（chronic lymphadenoid thyroiditis,CLT）并甲状腺腺瘤（thyroid adenoma,TA）的诊治经验。方法：对107例CLT并TA的临床资料进行回顾性分析。结果：107例中,术前诊断为桥本病并TA38例,正确诊断率为35.5%（38/107）,误诊、漏诊率为64.5%（69/107）。术中快速冷冻病理组织学检查确诊率为81.3%（87/107）。采用甲状腺部分、大部和次全切除术,81.3%（87/107）恢复良好;11.2%（12/107）出现声音嘶哑,治疗3个月后恢复;7.5%（8/107）出现手足抽搐,除1例治疗1年恢复外,其他7例患者均治疗2周后恢复。除3例双侧甲状腺全切除术患者需长期服用甲状腺素外,其余104例随访期间均未发生甲状腺功能减退。结论：CLT并TA诊断一旦确定,应积极手术治疗,根据术中快速病理组织学检查结果,选择手术方式和切除范围。术后根据FT3、FT4及TSH值可调整口服甲状腺素剂量。     

全腹腔镜脾切除术107例临床分析

目的:分析总结全腹腔镜脾切除术(laparoscopic splenectomy,LS)的手术技巧与临床应用价值。方法:2006年9月至2012年6月为107例患者行LS,其中外伤性脾破裂出血6例,特发性血小板减少性紫癜(idiopathic thrombocytopenic pur-pura,ITP)7例,自身免疫性溶血性贫血1例,脾囊肿4例,脾血管瘤4例,脾淋巴管瘤3例,脾错构瘤2例,脾结节样增生1例,脾脉管瘤1例,淋巴瘤2例,肝硬化门脉高压脾功能亢进76例。结果:105例成功完成全腹腔镜手术,2例中转开腹。术后2例出血,再次手术探查止血,其中1例经腹腔镜探查止血,1例开腹探查止血。28例联合行胆囊切除术、1例联合行阑尾切除术、3例联合行肝切除术;53例行贲门周围血管离断术。手术时间50～245 min,平均(122.5±55.6)min;术中出血量30～1 000 ml,平均(206.8±212.7)ml;术后住院5～15 d,平均(6.3±2.8)d。结论:LS安全、微创,术中应细致解剖,仔细操作,防止出血并安全有效地处理脾蒂是LS成功的关键。     

Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases

The classification of appendiceal mucinous tumors is controversial and terminology used for them inconsistent, particularly when they lack overtly malignant features but are associated with extra-appendiceal spread. We reviewed 107 appendiceal mucinous neoplasms and classified them as low-grade appendiceal mucinous neoplasm (LAMN) (n = 88), mucinous adenocarcinomas (MACAs) (n = 16), or discordant (n = 3) based on architectural and cytologic features. LAMNs were characterized by a villous or flat proliferation of mucinous epithelium with low-grade atypia. Thirty-nine tumors were confined to the appendix, but 49 had extra-appendiceal tumor spread, including 39 with peritoneal tumor characterized by mucin pools harboring low-grade mucinous epithelium, usually dissecting in a hyalinized stroma. Eight of the 16 MACAs lacked destructive invasion of the appendiceal wall and eight showed an infiltrative pattern of invasion. Extra-appendiceal tumor spread was present in 12 MACAs (four peritoneum, seven peritoneum and ovaries; one ovaries only). In MACAs with an infiltrative pattern, peritoneal tumor consisted of glands and single cells in a desmoplastic stroma. The peritoneal tumor in the remaining cases consisted of mucin pools that contained mucinous epithelium with high-grade atypia and, in some cases, increased cellularity compared with that seen in peritoneal spread in cases of LAMN. Three cases were classified as discordant because the appendiceal tumors were LAMNs but the peritoneal tumors were high-grade. Follow-up was available for 49 LAMNs, 15 MACAs, and 2 discordant cases. None of the patients with LAMNs confined to the appendix experienced recurrence (median follow-up 6 years). LAMNs with extra-appendiceal spread were associated with 3-, 5-, and 10-year survival rates of 100%, 86%, and 45%, respectively. Patients with MACA had 3- and 5-year survival rates of 90% and 44%, respectively (p = 0.04). The bulk of peritoneal disease correlated with prognosis among patients with MACA (p = 0.04) and, to a lesser degree, among patients with LAMNs (p = 0.07). We conclude that: 1) appendiceal mucinous neoplasms can be classified as either low-grade mucinous neoplasms or mucinous adenocarcinoma based on architectural and cytologic features; 2) tumors that can be confidently placed in the low-grade group (which requires rigorous pathologic evaluation of the appendix) and are confined to the appendix are clinically benign in our experience to date; 3) low-grade tumors confined to the appendix are morphologically identical to those with extra-appendiceal spread (except for the usual identification of breach of the wall in the latter cases) and the same designation is appropriate for the appendiceal neoplasia in each situation; 4) the long-term outlook for patients with low-grade tumors and peritoneal spread is guarded with just over half dying of disease after 10 years; 5) appendiceal mucinous tumors with destructive invasion of the appendiceal wall, complex epithelial proliferations, or high-grade nuclear atypia generally pursue an aggressive clinical course and should be classified as mucinous adenocarcinomas; 6) peritoneal tumor can be classified as involvement by LAMN or MACA, and this distinction is of prognostic significance; 7) bulky peritoneal tumor worsens prognosis; and 8) LAMNs associated with high-grade peritoneal tumor behave as adenocarcinoma.     

The management of chemical burns

In all reports on severe burns, those due to chemical mechanisms comprise less than 3–4% of the total admitted to hospital as opposed to other more frequent mechanisms such as fire, scalding, electrical and contact with hot solids. These burns have typical features which will be described. The diagnosis, treatment, and handling of these patients raises unique features since treatment should be specific depending on the causative agent. This must be identified, failure to do this leads to incorrect treatment and/or delay in beginning treatment. The incorrect antidote can cause additional problems. This paper describes the local and systemic characteristics of a diverse range of chemical burns and the methods of treatment. Received: 22 September 1998 / Accepted: 12 January 1999     

脊椎裂后遗足踝畸形的临床分析

目的 分析脊椎裂后遗足踝畸形的发病情况、临床特点、畸形类别与矫形治疗状况.方法 对我科1990年1月至2009年7月接受手术治疗脊椎裂后遗足踝部畸形患者进行回顾性研究,对资料进行总结分析.结果 手术治疗脊椎裂后遗足踝部畸形共107例患者.其中男性44例,女性63例;手术年龄1.3～52.0岁,平均17.7岁,其中18岁以上者50.5%(54/107).隐性脊椎裂50.5%(54/107),显性(囊性)脊椎裂49.5%(53/107).1例为胸椎裂(T3～8),余106例为腰骶椎裂.单侧足受累49例(左侧22例,右侧27例),双侧足受累58例,共165足.畸形类型:内翻足76足,外翻足23足,夏科连枷足15足,其他类足畸形51足.合并其他受累部位:膝部屈曲或膝反屈畸形4例,髋部畸形17例(包括髋内收、屈曲或髋关节脱位,骨盆倾斜、双下肢不等长等),合并大小便功能障碍30例.本组54例隐性脊椎裂致足踝畸形患者中,29例既往在多个医院未能确诊发病原因,误诊或漏诊的比率高达53.7%(29/54).107例患者中,既往接受过足踝畸形矫形手术者仅26例.18岁以上既往未能实施合理矫形外科治疗遗留严重足踝畸形者50.5%(54/107).结论 脊椎裂继发畸形主要在足踝部.由于缺乏对此病的整体认识与矫形治疗经验,延误了对此类疾病的早期诊断、早期干预的治疗时机,遗留了很多未经矫形外科治疗的严重足踝畸形.     

电视胸腔镜胸腺扩大切除治疗重症肌无力107例临床分析

目的探讨电视胸腔镜下胸腺扩大切除术治疗重症肌无力的临床效果。方法对1995年6月至2004年6月,台湾长庚纪念医院胸外科和北京大学人民医院胸外科根据临床表现及肌电图检查诊断证实为单纯重症肌无力,行电视胸腔镜胸腺完整切除及前纵隔脂肪组织廓清术治疗的107例患者的临床资料进行回顾分析。结果术后随访1—98个月,完全缓解34例,改善55例,全组完全缓解及改善率为83％,无手术死亡病例。结论电视胸腔镜下手术切除胸腺及前纵隔脂肪组织治疗重症肌无力临床效果良好,安全,创伤较小。     

输入性疟疾18例临床特点分析

@@     

色素血管性斑痣性错构瘤病23例临床分析

目的：探讨我科2001年来23例色素血管性斑痣性错构瘤病的临床表现及分型。方法：收集、研究和评价我院2001～2008年间23例色素血管性宽痣性错构瘤的资料,根据传统和Happle分类方法进行分型,总结其临床特征。结果：23例患者中以中年女性多见（15例）,平均年龄21．4岁。根据传统分类,最常见的为Ⅱ型,占78％,其次为IⅡ型,占13%根据Happle新分类方法,18例为phakomatosis ccsioflammca,3例为phakomatosis Spilorosca,2例为未分类型,18例有太田痣。结论：色素血管性斑痣性错构瘤病临床上较少见,往往因认识不够容易造成误诊及漏诊,详细询问病史和全面查体有助于准确的诊断。     

膀胱平滑肌瘤15例临床分析

目的探讨膀胱平滑肌瘤的临床表现、诊治方法和预后。方法回顾性分析1997年1月～2008年5月收治的15例膀胱平滑肌瘤患者的资料。其中男4例,女11例,年龄28~65岁,平均35岁。临床表现为排尿梗阻6例,排尿刺激症状5例,肉眼血尿3例,无任何临床症状体检时发现1例。病程1个月～3年,平均11．5个月。15例B超检查发现膀胱内占位病变,CT检查发现肿物均有不同程度强化,IVU检查12例发现膀胱充盈缺损,膀胱镜检查11例提示黏膜下占位。15例术前病理活检2例报告为平滑肌瘤。15例分别采用肿瘤剜除、膀胱部分切除和经尿道膀胱肿瘤电切术治疗。13例行术中冰冻切片检查,报告为平滑肌瘤。结果15例患者术后排尿通畅,排尿刺激症状明显缓解,血尿消失。未发生手术并发症。术后随访6个月～5年,平均3年,未见肿瘤复发或转移。结论影像学结合膀胱镜检查是诊断膀胱平滑肌瘤的主要手段,外科手术治疗预后良好。