原发性乳腺神经内分泌癌13例诊治分析

目的 探讨原发性乳腺神经内分泌癌的诊断和治疗策略。方法 结合文献对上海市第八人民医院普外科自1980年至今收治的13例原发性乳腺神经内分泌癌的分类、流行病学、诊断和治疗方法等进行分析。结果 13例中实体型原发性乳腺神经内分泌癌4例,小细胞型原发性乳腺神经内分泌癌5例,大细胞型原发性乳腺神经内分泌癌4,皆无腋窝淋巴结转移,总的5年无病存活率为76.9%（10/13）,存活率为84.6%（11/13）,病死率为15.4%（2/13）。结论 原发性乳腺神经内分泌癌的影像学诊断比较困难,诊断上的金标准是组织活检。在治疗上,参考乳腺浸润性导管癌的治疗策略对其治疗可获得较满意效果。     

乳腺疾病诊治的几个问题

1　乳腺增生症的中医分型为了辨证施治 ,一般把乳腺增生症分为 3～ 4型。根据多年乳腺专科的经验 ,我们认为乳腺增生症归纳为肝郁和肾虚两型最为合适。乳腺增生症起于肝 ,根于肾 ,治疗当按肝郁型、肾虚型分别论治。两型如何界定 ,简述如下。从年龄上分 :30岁以下多为肝郁型 ,4 0岁以上多为肾虚型。 30～ 4 0岁两型兼而有之 ,分月经前后用两种药。从症状上分 :以胀痛为主 ,月经前或生气后加重 ,即“随喜怒而消长”者为肝郁型 ;以肿块为主 ,痛无规律 ,反复发作 ,缠绵难愈 ,肢寒怕冷 ,腰酸尿频者为肾虚型。从肿块上分 :乳房胀满 ,腺体肥厚 ,质…     

能量发射波治疗乳腺肿块

乳腺肿块系因卵巢内分泌紊乱,孕激素水平低下,雌激素水平增高所致,乳腺主质和间质不同程度的增生。主要表现为乳腺单发或多发性结节或境界不清的乳腺增厚区,并有与月经周期相关的疼痛,部分病例有乳头溢液或溢血史。是育龄期妇女最为常见的乳腺疾病。1992年6月至1993年元月,我科应用能量型康复仪治疗育龄妇女乳腺肿块,方法简便,有效率为100%。一、临床资料     

乳腺导管扩张症的手术改进

乳腺导管扩张症是一种较少见的无菌性炎症性特殊类型乳腺病变 ,临床上主要表现为乳腺肿块或 /或乳头溢液 ,极易误诊误治。本病多需手术治疗 ,手术方式主要是包括病灶在内的乳腺局部切除。但因其病变边界不清 ,若切除不彻底容易复发。作者自 1999年起至今共治疗 5 2例病人 ,并对     

乳腺导管原位癌的治疗现状与进展

目的总结乳腺导管原位癌的治疗现状与进展。方法查阅近年来关于乳腺导管原位癌治疗现状与进展的文献资料,并作综述。结果随着乳腺导管原位癌发病率的增加,其治疗方法也在不断演变。外科治疗包括全乳切除术和保乳术（BCS）。保乳术联合放疗被认为是标准的减少局部肿瘤复发的方法。内分泌治疗也在临床上得到了重视及应用。结论保乳术与综合治疗已成为乳腺导管原位癌治疗的主要方法,需要通过进一步的研究来确定何种乳腺导管原位癌亚组只需行BCS术而不需要其他的辅助治疗。微创治疗将是乳腺导管原位癌治疗的一个发展方向。     

乳腺原位癌的诊治近展(文献综述)

乳腺原位癌是最早能从组织学上明确诊断的乳腺恶性肿瘤.其发现主要依靠乳腺X线钼靶摄片及细针穿刺定位切除活检.具体治疗方案尚无一致意见,采用乳房切除术治疗预后良好,保留乳房手术治疗(BCT)有一定的复发率.     

原原位癌的诊治近展：（文献综述）

乳腺原位癌是早早能从组织学上明确诊断乳腺恶性肿瘤。其发现主要依靠乳腺Ｘ线钼靶摄片及细针刺定位切除活检。具体治疗方案尚无一致意见，采用乳房节除术治疗预后良好，保留乳房手术治疗（ＢＣＴ）有一定的复发率。     

乳腺导管扩张症的临床特点与治疗

文中报告５４例乳腺导管扩张症，并根据症状特点将其分为溢液型、包块型、炎症型和混合型。较年长患者常以乳头溢液为主要表现（溢液型和混合型），其病理主要改变为导管扩张。而较年轻者常以包块为主要表现（包块型和炎症型），病理的主要改变为浆细胞乳腺炎。临床上前者常误为管内乳头状瘤，后者易诊为乳腺癌。针吸细胞学检查是一简单有效的诊断方法，凡属有乳房包块者均应列为常规，本组诊断符合率为８５．７１％。外科治疗主要针对扩张的导管及导管周围炎程度选择不同的治疗方法。     

“乳痛软坚丸”治疗肝郁气滞型乳腺增生病60例

目的探讨中药治疗肝郁气滞型乳腺增生病的疗效。方法采用＂乳痛软坚丸＂治疗肝郁气滞型乳腺增生病60例,对照组60例服用＂乳癖消＂。1个月经周期为l个疗程,经期停药,连续治疗3个疗程。结果治疗组与对照组的总有效率分别为98.3%、71.7%,两者比较差异有统计学意义（P〈0.05）。结论 ＂乳痛软坚丸＂对肝郁气滞型乳腺增生病具有良好的治疗作用。     

解剖型假体隆乳治疗重度乳腺发育不良

目的 探讨应用解剖型假体隆乳治疗重度乳腺发育不良的方法 及效果.方法 经乳晕切口或腋窝切口,对19例重度乳腺发育不良者应用解剖型假体行胸大肌下隆乳术,依据身高、胸围、胸骨上切迹-乳头(SN-N)间距离、乳头- 乳头(N-N)间距离、乳晕-乳房下皱襞(A-IMF)间距离等测量参数,并结合求美者的要求选择假体体积、突度、高度,术后根据求美者满意度判断手术治疗效果.结果 所有求美者获随访6个月至4年,19例重度乳腺发育不良者术后乳房呈现水滴状,乳头上翘,形态逼真,求美者均满意.结论 应用解剖型假体行胸大肌下隆乳术,是治疗乳腺组织发育不良者较理想的选择.     

Difficulties in the differential diagnosis of tuberculosis of the breast

An analysis of the own material and of literature data permits to note alterations in the clinical course of mammary gland tuberculosis, which is the manifestation of tuberculosis pathomorphism under modern conditions. The lesion of the mammary gland is most commonly an isolated disease. This interferes with the differential diagnosis between tuberculous mastitis and tumors of the mammary gland and supports the opinion that the spreading of infection from other old tuberculous foci via hematogenic path plays the main part in the pathogenesis of tuberculosis of the mammary gland.     

浆液细胞性乳腺炎(附22例报告)

本文报告了22例浆液细胞性乳腺炎。浆液细胞性乳腺炎又名乳导管扩张症,为一少见的乳腺良性疾病,临床上不易与乳腺癌、乳腺结核等区别而导致处理不当。肿块质硬、边界不清、多位于乳晕区,常伴有刺痛和反复发作史为其特点,据此可与乳腺癌相鉴别。手术是本病唯一的治疗方法。     

乳腺导管扩张症（附121例报告）

目的：探讨乳腺导管扩张症的病因,病理,临床分型,诊断与治疗,方法：分析1961年至1998年经手术病理证实的乳腺导管扩张症121例的临床资料。结果：根据临床表现可分为5种类型,即隐匿,肿块,脓肿,瘘管及共存型,提出诊断乳腺导管扩张症时应注意7点,根据临床分型可分别采用非手术疗法和不同的手术方式;乳管切除术,肿块局部切除术,乳腺区段切除术,单纯乳房切除术,切开引流术,瘘管切除术,乳房根治术。结论：乳腺导管扩张症有5种临床类型。根据临床表现,乳腺X线照片,乳腺导管造影及细针穿刺抽吸细胞学检查可以做出诊断,手术是治疗的主要手段。     

Abdominal tuberculosis--a disease revived.

Abdominal tuberculosis was common in the United Kingdom in the 18th and 19th centuries and in the first half of the 20th century. During the 1950's the recognition of Crohn's disease, the use of streptomycin and other drugs, and the pasteurisation of milk led to the virtual disappearance of abdominal tuberculosis in the western world. During the last two decades a new type, mycobacterium tuberculosis hominis, has appeared mainly in the immigrant population, especially in those from the Indian subcontinent. A retrospective review of 68 patients with abdominal tuberculosis is presented. The pathology, diagnosis and management of these cases is discussed, together with the differential diagnosis of Crohn's disease. It is suggested that the immigrant brings the disease into the United Kingdom in his mesenteric glands and that the disease is reactivated or 'revived' at some later date due to some modification of the immune process.     

Tuberculosis of the breast: rare but still extant. Review of the literature and report of an additional case

Tuberculosis of the breast is a rare malady that is usually manifested by a unilateral mass suggestive of carcinoma or sometimes of abscess. Mammography also suggests carcinoma in most instances. However, at operation, the discovery of necrotic tissue or abscess may lead to the suspicion of infectious or inflammatory disease rather than neoplasm. The diagnosis of tuberculosis may be established by the demonstration of acid-fast bacilli in excised tissue, by culture studies, or by guinea pig inoculation; however, the diagnosis is usually not suspected. In the past, mastectomy was the usual treatment. Today, successful treatment combines antituberculous drug therapy with the removal of infected breast tissue. The prognosis for complete cure is excellent. One case of secondary tuberculous mastitis has been reported herein. The patient, an Egyptian woman residing in the United States since 1973, was treated in Egypt for pulmonary tuberculosis at age 17. She presented in 1982 with a breast mass that mimicked carcinoma on physical examination and mammograms, but excisional biopsy and histologic examination revealed a breast abscess that contained caseous material and a solitary acid-fast bacillus. The patient was cured of her disease after appropriate operation and a course of antituberculous drugs. This has been the only documented case of mammary tuberculosis at our institution. Despite its rarity, tuberculosis of the breast should not be forgotten in this age of world travel.     

Acute intestinal tuberculosis

AIM OF STUDY: To report cases from Vietnam of intestinal tuberculosis disease, which is uncommon but did not disappear in occidental countries. MATERIALS AND METHODS: Seventy-six patients were included in this retrospective study. Mean age was 40 years and sex ratio M/F was 6. Diagnosis was established on pathological examination of resected specimen or on presence of Mycobacterium tuberculosis or by polymerase chain reaction. RESULTS: Intestinal obstruction or subobstruction was the most usual symptom (68%), and thereafter peritoneal symptoms with pain and tenderness (17%). Five patients had intractable digestive haemorrhage. Thirty-six patients had no past history or active pulmonary tuberculosis (47%). Lesions of stenosis on barium enema and thickness of intestinal wall on CT-scan were not specific. Sixty-two patients were operated on (82%) and 14 were not. Surgical techniques differed according symptoms, site and type of lesions. Intestinal resections were performed in half of the patients, others undergoing stomies or enterolysis. There were eight postoperative deaths (13% of patients operated on), seven out of these deaths were attributable to cachexy. In the postoperative period, all the patients were medically treated and follow-up in the antituberculosis centre of Hanoi. CONCLUSION: Symptomatology and operative findings of intestinal tuberculosis are similar to those observed in Crohn's disease, and sometimes in amoeboma or lymphoma. In face of stenosis and intestinal wall thickness, probability of intestinal tuberculosis is high in endemic area, but diagnosis must be suspected in occidental countries, mainly in patients immigrated coming from these areas, patients with immuno-deficiency even if they did not have past or present pulmonary tuberculosis.     

Tuberculosis of the breast]

The author observed 6 cases of mammary gland tuberculosis. 3 patients showed disseminated nodular form of mammary gland tuberculosis, 2--sclerotic form and 1--ulcerative form. Contrast-free mammography is an essential aid in diagnosis. Surgical intervention with postoperative specific antibacterial therapy is a radical method of treatment. Sectoral resection of the mammary gland should be carried out in young patients and amputation--in elderly ones.     

肾结核90例临床分析

目的 探讨肾结核的临床特征及有效治疗方法。方法 回顾性分析90例肾结核患者的临床资料。结果 近年来肾结核病例仍较多见，早期诊断困难，单纯药物治疗可治愈者约16％，手术切除仍是主要治疗方法。结论 不典型肾结核的发病率仍较高。尿常规、B超、静脉肾盂造影为主要诊断方法，诊断性治疗仍是确诊的重要依据。     

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.     

Unusual presentation of shoulder joint tuberculosis: A case report

Tuberculosis of the shoulder joint is uncommon. In adults the classical dry type of shoulder tuberculosis (caries sicca) has been described, while the fulminating variety has not been reported. We treated a case of fulminating variety of tuberculosis of the shoulder joint with anti-tubercular therapy and a shoulder immobilizer sling. At 18 months of follow up, the patient was disease free and had a good functional range of motion.