成人喉乳头状瘤恶变17例临床分析

目的 探讨成人喉乳头状瘤恶变的临床特征、病理特点及远期治疗效果.方法 对62例成人喉乳头状瘤患者手术前后的临床及病理资料进行分析.结果 62例成人喉乳头状瘤中发生恶变17例,其中术前经1次病理检查确诊者5例(29.4%),经2～7次病理检查确诊8例(47.1%),术后确诊4例(23.5%);其早期病理特征是部分区域恶变,而其他部位还保持着喉乳头状瘤的特点.其中声门型14例(T1N0M06例,T2N0M05例,T3N0M0 2例,T3N1M0 1例),声门上型3例(T4N0M01例,T4N1M02例).行全喉切除术4例,喉部分切除术13例,术后1年内全部拔管,拔管率100%.3年、5年生存率分别为88.2%(15/17)、76.5%(13/17).结论 必要时反复活检是术前确诊成人喉乳头状瘤恶变的重要方法,彻底的手术切除是其治疗的重要手段. Abstract： Objective To explore the malignant change of laryngeal papilloma in adults, especially its pathological figures, clinical characters and long -term results.Methods Analysis was made for the pre - and post - operated clinical and pathological dates of 62 laryngeal papilloma cases.Results Malignant changes had been found in 17 cases.Among these cases, 5 were diagnosed after 1 biopsy, 8were diagnosed after 2 up to 7 biopsies, 4 were diagnosed after surgeon.It was the character of earlier pathological changes that there were malignant changes in part areas, whereas normal papilloma in the other areas of the laryngeal neoplasm.There were 14 of 17 cases whose malignant changes were in glottis (T1N0M0 6 cases, T2N0M0 5 cases, T3N0M0 2 cases, T3N1M0 1 case).Malignant changes of the other 3cases were in supraglottic area(T4N0M0 1 case, T4N1M0 2 cases).Total laryngectomy was performed for 4 cases, and partial laryngectomy was selected for other 13 cases.The decannulation rate was 100% after 1 - year' s follow - up.The overall 3 - years and 5 - years survival rates were 88.2%(15/17)and 76.5%(13/17)respectively.Conclusions It is important to repeat biopsies if necessary to avoid fail to report the malignant change before surgeon.The key to cure it is completely removal of the tumor.     

Malignant change in a chronic skin lesion induced by an intravenous cannula.

A cutaneous wound subjected to continuous irritation has an increased potential for malignant degeneration. The types of trauma that may give rise to the initial injury are diverse and have been well documented. We report a case of one such lesion in a 65-year-old man who had a persistent right forearm wound for over three years. The wound arose from the site of venous cannula puncture. Malignant transformation occurred in a manner comparable to that seen in other chronic lesions (Marjolin''s ulcer).     

Malignant hyperthermia.

Malignant hyperthermia is a rare autosomal dominant trait that predisposes affected individuals to great danger when exposed to certain anaesthetic triggering agents (such as potent volatile anaesthetics and succinylcholine). A sudden hypermetabolic reaction in skeletal muscle leading to hyperthermia and massive rhabdomyolysis can occur. The ultimate treatment is dantrolene sodium a nonspecific muscle relaxant. Certain precautions should be taken before anaesthesia of patients known to be susceptible to malignant hyperthermia. These include the prohibition of the use of triggering agents, monitoring of central body temperature and expired CO2, and immediate availability of dantrolene. In addition, careful cleansing of the anaesthesia machine of vapours of halogenated agents is recommended. If these measures are taken, the chances of an MH episode are greatly reduced. When malignant hyperthermia-does occur in the operating room, prompt recognition and treatment usually prevent a potentially fatal outcome. The most reliable test to establish susceptibility to malignant hyperthermia is currently the in vitro caffeine-halothane contracture test. It is hoped that in the future a genetic test will be available.     

Malignant hypertension.

Malignant or accelerated hypertension is a life-threatening disease whose complications may be prevented by rapid reduction of the blood pressure. Diazoxide is presently regarded as the preferred therapeutic agent, but drugs such as trimethaphan, sodium nitroprusside, phenoxybenzamine and hydralazine may be useful in particular situations. Treatment is best carried out in an intensive care unit, where appropriate monitoring and study of the patient can be done. Since the introduction of antihypertensive agents the life expectancy of these patients, even those with renal insufficiency, has increased.     

Environmental dermatitis: contact dermatitis from Pinus radiata.

Various forms of contact dermatitis from Pinus radiata sawdust are described and illustrated by three cases. The sawdust causes industrial dermatitis which can be chronic and the purpose of the paper is to alert Australian practitioners.     

Plant hair dermatitis.

OBJECTIVE: To survey the ill effects of plant hairs on humans in Australia, incorporating new records. DESIGN: Retrospective analysis of new records, in some cases confirmed and supplemented by experimental skin contacts, along with a general survey of relevant literature. METHODS: Reports of accidental injuries submitted to the authors, through either medical or other sources, and to the Botanic Gardens of Adelaide and State Herbarium of South Australia, were studied and compared with existing literature; in some cases the effects were confirmed experimentally. RESULTS: A general survey of plant hair dermatitis in Australia is offered. Most species included have been referred to in the scattered earlier literature, but a few plants not previously recorded as irritating are included, notably Apalochlamys spectabilis, Wisteria sinensis and Grevillea species. Attention is also called to the penetrating and irritating pod spines of Brachychiton spp. (kurrajongs and relatives) and Lagunaria patersonii (Norfolk Island hibiscus or pyramid tree), which are often planted as ornamental street trees. Generally those most likely to receive these injuries are gardeners and children.     

Malignant phaeochromocytoma and hypercalcaemia.

We describe a case of hypercalcaemia secondary to recurrent malignant phaeochromocytoma. Parathyroid-related protein (PTHrp 1-86) immunoreactivity was identified in plasma and PTHrp was identified by immunocytochemistry in tumour tissue.