Galactorrhoea following hypophysectomy in a boy with a prolactinoma

An 18-year-old boy with delayed puberty was found to have a large prolactinoma. Hypophysectomy led to a fall in serum prolactin concentration, although it remained markedly elevated. The introduction of replacement therapy, including testosterone, resulted in painful swelling of the breasts and galactorrhoea. Bromocriptine therapy resulted in a cessation of galactorrhoea and normalization of serum prolactin concentrations. The absence of galactorrhoea in association with an astronomical concentration of prolactin, and its onset in association with diminished prolactin concentrations following hypophysectomy and the introduction of testosterone therapy, indicate that galactorrhoea requires the presence of high prolactin concentrations to act on mature breast tissue. This would account for the rarity of galactorrhoea in prepubertal children with prolactinomas.     

Treatment of presumed prolactinoma by transsphenoidal operation: early and late results

Seventy seven patients who were presumed to have a prolactinoma on the basis of biochemical findings underwent transsphenoidal operation between October 1977 and September 1983. Sixty one patients were found to have a microadenoma, and hyperprolactinaemia was cured in 46 of these, amenorrhoea in 39 (80% of those with the symptom), galactorrhoea in 32 (80%), and infertility in 31 (82%). Four of eight patients found to have a macroadenoma were also satisfactorily treated with surgery. Two patients had a lesion other than a prolactinoma, and in six a tumour could not be found at operation; four of these last eight patients had a normal serum prolactin concentration after operation. Recurrent hyperprolactinaemia was rare, occurring in only three patients in the series overall; among the 32 patients followed up for more than five years only two of the 22 whose operation had initially been successful developed recurrent hyperprolactinaemia.     

Galactorrhoea, hyperprolactinaemia, and pituitary adenoma presenting during metoclopramide therapy

A 49-year-old woman presented with a one month history of headaches, loss of libido and galactorrhoea. She had been taking metoclopramide for the previous 3 months for reflux oesophagitis. She was found to have substantially elevated serum prolactin levels and a pituitary adenoma, which have not been previously described in a patient taking metoclopramide. The drug was stopped and the serum prolactin level fell progressively to normal with resolution of symptoms over 4 months. This suggested that contrary to our original impression that she had a prolactin-secreting pituitary adenoma which had been stimulated by metoclopramide, she had metoclopramide-induced hyperprolactinaemia and an incidental pituitary tumour.     

Restoration of fertility in prolactin induced premature menopause

A case of infertility associated initially with amenorrhoea only and then with amenorrhoea and galactorrhoea following a successfully induced pregnancy is reported. In a period of eight years of continuous investigation and treatment this subject’s infertility first responded to sequential clomiphene and human chorionic gonadotrophin (HCG) therapy resulting in a normal pregnancy. Subsequently she became refractory to this therapy. The availability of specific prolactin assays and a prolactin inhibitor (2-Br-α-ergocryptine, bromocriptine Sandoz) identified the aetiology of her amenorrhoea/galactorrhoea/infertility and provided a new mode of therapy. Planned conception has been achieved on three occasions, producing two normal males and a normal female child.     

Serum prolactin levels in normal women and in women with disorders of menstruation

The mean (+/-SD) serum prolactin (PRL) level of 78 normal premenopausal women was 10-6+/-3-0 ng/ml, and this was significantly different from that of post-menopausal women (8-2+/-4-0 ng/ml) and women taking combined oral contraceptive preparations (12-2+/-4-0 ng/ml). No significant differences were found between follicular and luteal phase PRL levels. Serum PRL levels higher than the ranges given above were found in 31 of 87 patients with secondary amenorrhoea and two of 41 patients with oligomenorrhoea. Nine of the 33 patients with hyperprolactinaemia did not have galactorrhoea. Only two of the patients with hyperprolactinaemia had pituitary tumours evident on skull X-ray films. Serum PRL levels were of value in predicting the likely success in achieving ovulation with clomiphene citrate or CB-154; clomiphene citrate was less likely to be successful in the presence of hyperprolactinaemia, whereas the reverse applied for treatment with CB-154.     

家兔胸部爆炸伤早期血液流变学变化

目的：探讨家兔胸部爆炸伤后早期血液流变学变化规律及其对肺脏等脏器功能的影响．方法：健康中国家兔随机分为对照组和伤后5，30，60，180和360min5个时相点观察组，观察血液流变学及肺组织病理学动态变化．结果：家免爆炸伤后早期全血粘度、血浆粘度、红细胞聚集指数、血浆纤维蛋白原含量及红细胞变形性均低于正常对照组，30min以后上述指标明显升高，180min后达峰值，与正常对照组相比有非常显统计学意义(P＜0．01)，伤后360min虽有所下降，但仍高于正常对照组(P＜0．05)；肺组织病理学变化与血液流变学变化基本一致．结论：家免胸部爆炸伤后血液流变特性明显改变，血液粘滞性增加，从而加重微循环障碍导致脏器功能损伤．     

Long-term follow-up of transsphenoidal selective adenomectomy for prolactinoma

Although transsphenoidal selective resection of prolactinoma has high cure rates and low morbidity, the frequency of late recurrence of adenoma is controversial. Long-term follow-up data were available on 29 of our patients having initial return to normal prolactin levels after microadenoma resection; in 24, prolactin levels remained normal at 50 +/- 3 months' (range, 11 to 81 months) follow-up. Five patients manifested hyperprolactinemia again after intervals of six to 16 months. In five patients with normal prolactin levels immediately after macroadenoma resection, who were available for long-term follow-up, prolactin levels remained normal in four at 41 +/- 3 months; one patient had a relapse 78 months after surgery. Testing of prolactin secretory dynamics six weeks postoperatively was not predictive of who would suffer relapse. It is not known whether these relapses are due to regrowth of tumor remnants or represent new tumor formation.     

肿胀吸脂联合乳晕下弧形切口治疗中重度男性乳房肥大症

目的探讨肿胀麻醉吸脂联合乳晕下缘弧形微创切口腺体切除术治疗男性乳房肥大的方法和临床疗效。方法自2002年4月—2012年6月,收治29例男性乳房肥大患者。年龄16～47岁。单侧3例,双侧26例。其中脂肪型14例,脂肪混合型13例,腺体型2例。其中3例PRL、LH、FSH、E2水平增高,睾酮水平较低;其余患者体内相关激素水平正常,以上患者均采用肿胀吸脂联合乳晕下弧形切口腺体切除术。结果 1例患者于术后2 d出现皮下血肿,经对症处理后最终一期愈合;1例乳头下乳腺组织残留过多,经二次整复后效果满意,其他病例切口均Ⅰ期愈合。未见乳头、乳晕缺血、坏死及乳头感觉功能减退等并发症发生。20例患者随访,随访日期6～24个月,乳房外形良好,无复发。结论肿胀吸脂联合乳晕下弧形切口腺体切除术具有瘢痕小、安全性高、外观自然、患者满意度高等优点,是目前治疗男性乳房发育有效方法之一。     

贾英杰教授运用三焦理论辨治放射性肺损伤经验拾遗

放射性肺损伤是肺恶性肿瘤放疗后常见的并发症,临床症状有咳嗽、胸闷气急、胸痛等,甚可致肺源性心脏病,严重影响患者的生活质量及放疗的治疗效果。贾英杰教授撷三焦理论之精华,把握辨治节点,分期论治,临床疗效甚佳。     

男性多发伤患者早期血清泌乳素变化及临床意义

目的研究男性多发伤特别是颅脑创伤患者早期血清泌乳素（PRL）变化特点与临床意义。方法收集男性多发创伤患者90例,按照创伤严重评分（ISS）对多发伤严重程度予以评分分组,按格拉斯哥评分（GCS）对合并颅脑损伤患者进行评分分组;分别在伤后12 h内、第24及72 h测定血清PRL含量并进行组间比较;以15例同龄段健康男性为对照组。结果对照组的PRL含量为（212.7±77.7）mU/L;多发创伤患者在伤后24 h内创伤越重,血清PRL水平升高越明显,其中在伤后12～24 h ISS评分分值越高血清PRL含量升高越明显;ISS〈16分组（A组）、25分≥ISS≥16分组（B组）及ISS〉25分组（C组）与对照组比较差异有统计学意义（P〈0.05）,且各组间两两比较差异有统计学意义（P〈0.05）;至伤后72 h三组患者血清PRL水平下降,与对照组比较差异有统计学意义（P〈0.05）。合并颅脑损伤的5分≥GCS≥3分组与8分≥GCS〉5分组均明显高于对照组（P〈0.01）;伤后72 h各组血清PRL水平开始下降。结论严重创伤及颅脑损伤男性患者早期血清泌乳素水平的改变与创伤严重度特别是颅脑损伤的严重程度有关,提示血清泌乳素有望作为评估男性多发伤患者创伤严重程度的参考指标。     

Minimising delays to thrombolysis in patients developing acute myocardial infarction in hospital.

We investigated the clinical features and management of 50 patients presenting with acute myocardial infarction from the community and 50 patients presenting with cardiac symptoms who developed an infarct after being admitted to a general medical ward for observation. Nineteen of the 50 patients initially admitted to non-specialist wards were found retrospectively to have sustained an infarct prior to hospital admission. Of the remaining 31 admission in this group, 24 developed symptoms within 24 hours of admission, 26 presented with chest pain, while 21 had evidence of acute coronary ischaemia on the admission electrocardiograph. Of the 26 patients who presented with chest pain, 20 were treated with aspirin, 13 with intravenous nitrate and four with heparin. Median delay from onset of symptoms to thrombolysis with in-hospital patients was 120 minutes and for community patients 287 minutes. Interestingly, the greatest component of this delay in both groups was the time taken for patients to decide to seek assistance after developing acute symptoms. Patients at high risk of developing acute myocardial infarction within 24 hours of hospital admission may be identified by a history of chest pain and electrocardiographic evidence of acute coronary ischaemia at admission. Such patients may experience suboptimal treatment and delays to thrombolysis if admitted to nonspecialist wards, but this may be reduced by admitting all ''high risk'' patients directly to a high dependency cardiac ward for the first 24 hours after presentation.     

重型颅脑损伤混着转出ICU后家属迁移应激评估及影响因素的研究

目的 调查分析重型颅脑损伤患者转出重症监护病房（intensive care unit,ICU）后其家属的迁移应激情况及其影响因素。方法 选择2015年1月～2018年1月在我院ICU治疗后成功转出的80例重型颅脑损伤患者家属,对其迁移应激状况进行调查,统计其转出迁移应激评分,将其分为重度迁移应激反应组和轻中度迁移应激反应组,对影响重型颅脑损伤患者转出ICU后其家属迁移应激状况的危险因素进行分析。结果 重型颅脑损伤患者家属的ICU转出迁移应激评分平均为（54.38±13.92）分,经单因素分析、多因素Logistics线性回归分析后发现,家属性别、家属文化程度、患者ICU治疗时间、患者年龄是影响重型颅脑损伤患者转出ICU后其家属迁移应激状况的危险因素。结论 重型颅脑损伤患者转出ICU后其家属受到性别、文化程度、患者ICU治疗时间、患者年龄等因素的影响,容易出现迁移应激反应,护理方面应针对患者家属迁移应激状况实施针对性干预。     

环抱型肋骨接骨板治疗连枷胸手术时保留骨膜的临床疗效分析

目的 探讨环抱型肋骨接骨板治疗连枷胸手术时保留骨膜的临床疗效。方法 回顾性分析河北医科大学第一医院2013年10月～2015年5月收治的54例经影像学诊断为连枷胸患者的临床资料,分析比较患者在接受环抱型肋骨接骨板治疗连枷胸手术时保留骨膜治疗前后患者的心率、呼吸频率、血氧饱和度、肺功能、疼痛程度差异,同时对患者进行6个月的随访,观察患者的骨折愈合情况。结果 54例患者均骨性愈合,治疗后患者的心率、呼吸频率、血氧饱和度、肺功能及疼痛程度均较治疗前明显改善,差异有统计学意义（P<0.05）。结论 环抱型肋骨接骨板治疗连枷胸手术时保留骨膜临床疗效显著,能显著改善患者的生活质量及肺功能,值得临床推广。     

外伤性迟发性血气胸的诊治探讨

报告了１６例外伤性迟发性血气胸，占同期胸外伤的４．９８％（１６／３２１）。作者强调，对任何一位胸外伤患者都要警惕迟发性血气胸的发生，伤后一月内要定期作胸部Ｘ线检查，一旦确诊迟发性血胸，尽早行闭式引流，引流时间以一周左右为宜     

改良Nuss术治疗小儿漏斗胸905例

目的总结漏斗胸手术方法、并发症及相关临床经验。方法选择2004年1月至2016年12月胸腔镜辅助下改良Nuss术治疗905例漏斗患儿,其中男708例,女197例。年龄3岁8个月～17岁（9.35±4.17）岁,合并畸形25例（2.76%）。结果905例均顺利完成手术,手术时间25～80（41±9）min,出血量1～20ml,术后住院平均5.5d。发生早期并发症共52例（5.75%,发生2种及以上并发症11例）,其中心包损伤15例（1.66%）,气胸18例（1.99%）,胸腔积液12例（1.33%）,切口愈合不良10例（1.10%）,应激性溃疡12例（1.33%）。发生晚期并发症16例（1.77%）,其中脊柱侧弯和（或）支架移位8例（0.88%）,过敏8例（0.88%）。68例（7.51%）患儿发生并发症,共83例次。近2年内并发症发生明显减少,无心包损伤、二次手术、支架移位等严重并发症。随访3个月至10年,矫形效果达优良者695例（96.4%）。结论改良胸腔镜辅助下Nuss术治疗儿童漏斗胸安全可行,矫形效果满意,改良后手术方式更安全,切口更美观,手术更微创。对于Haller指数＞4,不对称型患儿,术前/术中胸壁负压盘的应用可减少并发症的发生,简便易行,是一种可为改良Nuss术提供安全保障的辅助方法。患儿手术最佳时机为6～12岁,可扩展至3.5～17岁,远期效果良好。     

Galactorrhoea and pituitary mass: a typical prolactinoma?

A 21 year old woman presenting with galactorrhoea, hyperprolactinaemia, and a pituitary mass on magnetic resonance imaging (MRI) is described who was referred to us before planned pituitary surgery. Although a thorough history did not suggest hypothyroidism, laboratory studies revealed profound primary hypothyroidism. At that time, pituitary MRI showed homogeneous enlargement of the pituitary gland consistent with pituitary hyperplasia due to primary hypothyroidism. With thyroid hormone replacement therapy the galactorrhoea resolved, concentrations of prolactin and thyroid hormones returned to normal, and the pituitary shrunk to normal size within two months. This case illustrates that primary hypothyroidism can present only with galactorrhoea and pituitary mass, and should therefore be considered in the differential diagnosis of hyperprolactinaemia and pituitary enlargement.     

胸壁肿瘤组织中IL-17和IL-4蛋白表达特点及其与病理特征及预后的关系

目的探讨胸壁肿瘤组织中IL-17和IL-4蛋白表达特点及其与病理特征及预后的关系。方法选取2011年1月至2013年6月于我院进行手术治疗的胸壁肿瘤患者48例为研究对象,采用免疫组化法检测其切除肿瘤组织及肿瘤旁组织中IL-17和IL-4蛋白表达水平。术后患者均随访超过3年,统计其临床病理特征和3年生存预后。比较不同肿瘤组织IL-17和IL-4蛋白表达水平患者的病理特征和预后并采用Logistic关系分析法分析其与患者的病理特征和预后的关系。采用受试者操作特性曲线(ROC)分析胸壁肿瘤组织中IL-17和IL-4蛋白表达水平预测其预后的价值。结果胸壁肿瘤组织中IL-17和IL-4蛋白表达水平分别为70.83%和72.92%,高于其肿瘤旁组织的43.75%和37.50%(P<0.05)。与胸壁肿瘤组织中IL-17阴性表达患者比较,胸壁肿瘤组织中IL-17阳性表达患者的肿瘤直径增大,3年生存率则降低(P<0.05)。胸壁肿瘤组织中IL-4阳性表达患者的肿瘤直径亦较IL-4阴性表达患者增大,3年生存率亦较IL-4阴性表达患者降低(P<0.05)。Logistic关系分析结果显示,胸壁肿瘤组织IL-17和IL-4蛋白表达水平与其肿瘤直径以及生存预后均密切相关(P<0.05)。ROC曲线分析结果显示胸壁肿瘤组织中IL-17和IL-4蛋白表达水平单独和联合预测其预后的价值良好,其中以两者联合预测预后的价值最优。结论胸壁肿瘤组织中IL-17和IL-4蛋白阳性表达率高且均与其病理特征及预后相关,两者联合预测患者预后的价值良好。因此,胸壁肿瘤组织中IL-17和IL-4蛋白表达水平可能作为其病理特征和预后的评估参考指标。     

经鼻蝶入路鞍区占位切除术治疗伴高泌乳素血症无功能垂体腺瘤的疗效

目的 探讨伴高泌乳素血症的无功能腺瘤经鼻蝶手术的治疗疗效。方法 回顾性分析我科2015-2019年收治的伴有高泌乳素血症的临床无功能腺瘤患者共80例,泌乳素水平在25~200ng/ml之间,所有患者均接受经鼻蝶入路鞍区占位切除术并且术后病理排除PRL染色阳性的病例。分析患者的临床特征,手术方式,术后并发症,术前后高泌乳素血症及临床症状的缓解及其之间的相关性。结果 研究共纳入男性21例,女性59例,术前中位泌乳素水平51.11ng/ml（25.2-136.52ng/ml）,中位肿瘤体积3.99cm3（0.23-37.11cm3）,头痛为最常见的首发症状（37.5%）,女性以性腺功能紊乱起病的患者多于男性（28.8% vs 9.5%,p=0.031）,男性在就诊时更容易出现2条以上激素功能轴减退（47.6% vs 15.3%,p=0.031）。术后高泌乳素血症缓解65人（81.3%）,高泌乳素血症的缓解与患者性别,年龄,肿瘤体积及手术切除程度无明显相关性,多因素分析显示仅术后第1天泌乳素水平可以预测3个月后的高泌乳素血症缓解（p=0.001）。术后患者视力视野改善率87.9%,头痛症状改善率93.9%,术前存在月经紊乱的绝经前女性中,14名（82.4%）术后恢复正常月经周期。结论 手术治疗是伴有高泌乳素血症的无功能腺瘤患者的可靠治疗选择。     

以碘仿纱条为支撑材料经鼻内镜鼻窦入路治疗成人眶爆裂性骨折疗效观察

目的 探讨以碘仿纱条为支撑材料经鼻内镜鼻窦入路治疗成人眶爆裂性骨折的临床疗效。方法 76例保守治疗无效的眼眶爆裂性骨折患者,其中男57例,女19例,年龄18~57岁,平均38.1岁。拳击伤44例,车祸伤17例,摔伤8例,外物砸伤7例。左侧伤63例,右侧伤13例。眶下壁骨折49例,眶下壁合并眶内壁骨折16例,眶内侧壁骨折11例。合并鼻骨骨折17例,上颌骨额突骨折9例,鼻中隔骨折5例,上颌窦骨折5例,颧骨骨折3例,肋骨骨折2例,鼻中隔血肿2例。均伴有不同程度复视及眼球内陷（两眼相差最小2 mm,最大达6 mm）,26例出现视力下降。经鼻内镜鼻窦入路治疗眶内壁和（或）眶下壁骨折,以碘仿纱条作为支撑材料填塞3周。术后3个月观察患者复视状态、视力情况,双眼球突出度以及是否伴有眶内及颅内并发症等。结果 随访3~51个月,平均11.7个月。术后3个月时评估疗效,眼球凹陷恢复满意（双眼球突出度相差均稳定在2 mm以内）。71例复视完全消失,4例第1眼位无复视,向上注视时有部分复视,对患者生活影响有限,患者接受;1例患者术后复视恢复不满意。伤后视力下降患者术后视力均恢复伤前水平。未发生眶内及颅内并发症。结论 经鼻内镜鼻窦入路眶下壁和（或）眶内侧壁骨折整复术视野开阔,钝性复位眶内容,避免眶内结构的新创伤。碘仿纱条经济、长度调节便利、支撑确切、有效预防感染,且为非永久性留置,避免了长期植入材料可能出现的各种并发症。     

Massive prolactinoma with galactorrhoea in a prepubertal boy

An 8 year old prepubertal boy presented with raised intracranial pressure, left proptosis and was noted to have galactorrhoea. Cranial computerized tomography revealed a large pituitary tumour infiltrating the cavernous sinus and left orbit. The serum prolactin was 180,600 mU/l (normal value less than 360 mU/l). Prolactinomas are rare in children and galactorrhoea has not previously been reported in a prepubertal child. The management of massive prolactinomas is difficult, but the child presented has made an impressive response to a combination of treatment with surgery, dopamine agonist therapy and radiotherapy.