男性睾酮缺乏症的诊治进展

1 前言 男性睾酮缺乏症(简称睾酮缺乏症)是指由于下丘脑-垂体-性腺(HPG)轴的某一或某些部位病变导致睾丸不能产生生理水平的睾酮以及正常数量精子的一种疾病.其病因可为原发性的,也可为继发性的.原发性睾酮缺乏症表现为睾酮水平低、精子形成障碍但促性腺激素水平增高.继发性睾酮缺乏症表现为精子形成障碍、睾酮水平低及促性腺激素水平低或正常[1,2].     

雄激素缺乏与勃起功能障碍

雄激素可通过增强性欲、性唤起等间接促进阴茎勃起,在维持阴茎正常的勃起组织结构方面起重要作用。睾酮缺乏可导致小梁平滑肌减少、细胞外基质增多、白膜下脂肪细胞沉积等。勃起时,阴茎组织的上述改变可引起静脉闭塞不全而发生静脉漏,从而出现勃起功能障碍;睾酮还可影响一氧化氮合酶(NOS)、RhoA/Rho激酶的表达及活性从而直接影响阴茎勃起。对单用磷酸二酯酶5(PDE5)抑制剂无反应的性腺功能减退的ED患者补充睾酮可收到良好的治疗效果。     

The Comparison of the Aging Male Symptoms (AMS) Scale and Androgen Deficiency in the Aging Male (ADAM) Questionnaire to Detect Androgen Deficiency in Middle-Aged Men

The prevalence of androgen deficiency in men increases with aging. Two common instruments, the Aging Male Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire, are often used to screen for androgen deficiency in clinical practice. The aim of this study is to compare the capability of the AMS scale and the ADAM questionnaire to detect androgen deficiency in middle-aged Taiwanese men. In April 2008, a free health screening was conducted by Kaohsiung Medical University Hospital. All participants completed a health questionnaire and had blood samples drawn between 8:00 am and noon. Serum total testosterone (TT), albumin, and sex hormone-binding globulin levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms associated with androgen deficiency were screened by using the AMS scale and ADAM questionnaire. Androgen deficiency was defined as TT < 300 ng/dL or both TT < 300 ng/dL and FT< 5 ng/dL. In total, 339 men were included in the final analysis, with the mean age of 54.6 ± 4.9 years (range, 47-65 years). Androgen deficiency was found in 75 men (22.1%) based on the criteria of TT < 300 ng/dL, and in 54 men (15.9%) based on the criteria of TT < 300 ng/dL and FT < 5 ng/dL. When detecting participants with both TT < 300 ng/dL and FT < 5 ng/dL, the sensitivity and specificity of the AMS scale were 57.4% and 48.1%, compared with 66.7% and 25.6% for the ADAM questionnaire. In a sample of middle-aged Taiwanese men, neither the AMS scale nor the ADAM questionnaire had sufficient sensitivity and specificity to detect androgen deficiency. In addition to using those 2 screening instruments, a thorough physical and biochemical workup should still be conducted in patients at risk or suspected of androgen deficiency.     

原发性主动脉消化道瘘的诊断和治疗(1例报道并文献复习)

目的探讨原发性主动脉消化道瘘的诊断和治疗。方法报道1例原发性主动脉消化道瘘的诊治经过,并复习有关文献。结果本例为67岁男性患者,以＂腹部不适伴反复便血7个月＂入院。急诊行剖腹探查,结合术中肠镜发现腹主动脉瘤十二指肠瘘。十二指肠第3段瘘口用5-0普理灵修补缝合;行腹主动脉瘤切除,用16mm&#215;8mm分叉涤纶人造血管行腹主动脉-人造血管-左髂总动脉、右髂外动脉吻合。术后静脉使用三代头孢抗生素3周,后改用口服抗生素,无发热,切口一期愈合,顺利出院。结论原发性主动脉消化道瘘罕见、死亡率高,应注意与主动脉瘤患者的消化道出血鉴别。及时诊断和快速外科治疗是提高存活率的关键。     

肾转移癌的诊断和治疗（附6例报告并文献复习）

目的：探讨肾转移癌的诊断和治疗。方法：对6例确诊为肾转移癌患者的临床资料进行回顾性分析。6例肾转移癌分别来源于肺癌、胃癌、结肠癌、食道癌。根据手术或穿刺活检病理确诊。结果：肾转移癌无特异临床表现,单发性病变是最常见的CT表现。综合治疗后生存期6～28个月,平均生存时间13．2个月。死亡4例,存活2例。结论：肾转移性癌临床上较为少见,应根据不同的原发肿瘤选择合适的综合治疗方式。     

膀胱间质瘤的诊断与治疗（附1例报告及文献复习）

目的：探讨胃肠道外间质瘤（extra-gastrointestinal stromal tumor,EGIST）,尤其膀胱间质瘤的临床表现、诊断与治疗.方法：报告我院于2010年6月1日～7月2日收治的1例膀胱间质瘤患者的临床资料并对相关文献进行复习.结果：本例患者行膀胱全切术.病理结果：光镜下见黏膜上皮增生.Brunn巢形成;免疫组化染色：CD117阳性,诊断为膀胱间质瘤.术后定期随访未见肿瘤复发及转移.结论：膀胱间质瘤临床上罕见,无特征性临床表现,治疗以手术切除为主.转移和不能手术切除的患者采用分子靶向治疗.     

肾恶性间叶瘤的诊断与治疗（附3例报告并文献复习）

目的：探讨肾恶性间叶瘤的诊断、治疗及预后.方法：回顾性分析3例肾恶性间叶瘤患者的临床资料：男2例,女1例.年龄48～68岁,平均57岁.CT平扫均为肾脏巨大不均质肿物,其中伴有大块状钙化2例,增强扫描不均质肿物有轻至中度强化.3例患者均行根治性肾切除术,术后辅以化疗或放疗.结果：3例患者术后存活6～18个月,平均11个月.结论：肾恶性间叶瘤临床罕见,术前诊断困难,确诊需依靠病理检查.综合分析临床资料及提高对此病的临床认识是避免误诊的关键.根治性切除术是其主要治疗手段,但预后不佳.     

Diagnosis and Treatment of Sporadic and Familial Adenomatous Polyposis (FAP) - Associated Desmoid Tumors: Literature Review

Desmoid tumors account for 3% of all soft tissue tumors and 0.03% of all neoplasms. In some cases, they appear as part of various syndromes, such as familial adenomatous polyposis (FAP). Desmoids are associated with CTNNB1and APC mutations, which exclude each other. Desmoid tumors appear as slowly growing masses that often do not cause symptoms. The natural course of desmoids varies and is unpredictable. Most patients feel relieved by the benign diagnosis and underestimate the aggressive behavior of the disease.Various imaging techniques have been used for diagnosis and monitoring of desmoids, including ultrasound (U/S), magnetic resonance imaging (MRI), computed tomography (CT) scan, positron emission tomography (PET) scan and plain X-ray. The definitive diagnosis requires biopsy.Desmoids usually express β-catenin and vimentin. Sporadic tumors are associated with CTNNB1 mutation of β-catenin. If this mutation is identified, the presence of any syndrome can be excluded. FAP is inherited in an autosomal dominant fashion and is caused by a mutation of the APC gene; 10-15% of patients with FAP develop desmoid tumors while 7.5-16% of desmoids are a manifestation of FAP.The basic therapeutic approaches are surgical excision, radiotherapy and medical treatment with anti-estrogen, nonsteroid anti-inflammatory drugs (NSAIDs), cytotoxic chemotherapy and molecular therapies. Close observation of the disease progress is imperative, whether the “wait and watch” strategy has been chosen or a specific treatment has been applied. Imaging, preferably MRI, should be performed every 3 months for the first year after diagnosis, every 6 months for the second year and annually thereafter.     

胰腺恶性纤维组织细胞瘤的诊治（附1例报道并文献复习）

目的 探讨胰腺恶性纤维组织细胞瘤的诊断及治疗.方法 对兰州大学第一医院收治的1例胰腺恶性纤维组织细胞瘤患者,结合国、内外文献对其临床特点,影像学、病理学及免疫组化特征、治疗和预后进行分析.结果 行胰腺肿瘤切除,术后医用直线加速器采取三维适形精确放疗,随访9个月,未见肿瘤复发.结论 胰腺恶性纤维组织细胞瘤恶性度高,易复发、转移,生存率低,诊断主要依靠病理和免疫组化检查.外科手术联合放射治疗可延长生存时间和延缓肿瘤的复发.     

化疗性口腔黏膜炎防护的研究进展

对化疗性口腔黏膜炎的病因、发病机制.以及口腔黏膜炎的预防、治疗和护理的研究进展进行介绍.旨在为护士选择适宜的护理措施.防治化疗性口腔黏膜炎.以保障化疗的顺利进行.提高肿瘤患者的生存质量.     

Diagnosis and Management of the Symptomatic Duodenal Diverticulum: a Case Series and a Short Review of the Literature

Introduction  The incidence of duodenal diverticula (DD) found at autopsy may be as high as 22%. Perforation is the least frequent but also the most serious complication. This case series gives an overview of the management of this rare entity. Methods  This study is a case series of eight patients treated for symptomatic DD. Results  Two patients had a perforated DD. One perforation was in segments III–IV, which to our knowledge is the first published case; the other perforation was in segment II. A segmental duodenectomy was performed in the first patient and a pylorus-preserving duodeno-pancreatectomy (pp-Whipple) in the second. A third patient with chronic complaints and recurring episodes of fever required an excision of the DD. In a fourth patient with biliary and pancreatic obstruction, a pp-Whipple was carried out, and a DD was discovered as the underlying cause. Four patients (one small perforation, one hemorrhage, and two recurrent cholangitis/pancreatitis caused by a DD) were treated conservatively. Conclusions  Symptomatic DD and, in particular, perforations are rare, encompass diagnostic challenges, and may require technically demanding surgical or endoscopic interventions. The diagnostic value of forward-looking gastroduodenoscopy in this setting seems limited. If duodenoscopy is performed at all, the use of a side-viewing endoscope is mandatory.     

护士职业生涯规划管理的研究进展

从护士职业生涯规划的概念、意义、教育与辅导以及步骤和内容方面进行综述,并提出了目前职业生涯规划中存在的问题及解决办法.建议进一步提高医院对护士职业发展的重视,帮助护士落实职业发展的有关计划,正确引导护士的职业发展.     

原发性甲状腺鳞状细胞癌的诊断与治疗(附1例典型病例报道并文献复习)

目的探讨原发性甲状腺鳞状细胞癌的诊断和治疗。方法回顾性分析我院收治的1例原发性甲状腺鳞状细胞癌典型病例,并结合相关文献复习,探讨其诊断和治疗。结果该例肿瘤侵及甲状软骨、环状软骨和喉,行甲状腺癌联合喉扩大切除术。术后发生甲状旁腺功能低下和手足抽搐,术后第15天出院。随访1年健康生存,未见复发和远处转移。结论原发性甲状腺鳞状细胞癌罕见,早期诊断困难,恶性程度高,积极手术是首选的治疗方法。放射治疗可延缓肿瘤的生长、转移。     

Non-Neoplastic Cystic Lesions of the Sellar Region Presentation, Diagnosis and Management of Eight Cases and Review of the Literature

Summary  The differential diagnosis of a sellar lesion includes pituitary adenoma, cranio-pharyngioma, tumour cyst, benign cyst, and other less common lesions such as aneurysm, squamous cell carcinoma and metastases. Pure cystic lesions within the sella turcica are not uncommon and may appear clinically and radiologically as pituitary adenoma. Intrasellar cysts are broadly classified as neoplastic or non-neoplastic; the latter may be primary lesions of the pituitary fossa or they may arise from the parasellar region and invade into the sella. The lesions occupy space and may cause disturbance of pituitary function; if they extend into the suprasellar region they can affect visual fields and acuity. Non-neoplastic cystic lesions usually appear well defined radiologically and have distinct pathological features. Modern imaging modalities, such as computed axial tomography and magnetic resonance imaging, are important complementary tools of investigation for reaching a differential diagnosis, and for surgical planning. Most non-neoplastic sellar cysts can be approached through the trans-sphenoidal route, but large lesions with suprasellar extension may require transcranial surgery.  We report the presentation and management of eight cases (four males, four females, all adult) of non-neoplastic cyst involving the sella turcica and the parasellar region. Investigations included computed tomography scan of the head for all and magnetic resonance imaging for six (75%) patients. Work-up included endocrinological and opthalmological evaluations. All presented with headache; six (75%) had visual acuity change, two (25%) had evidence of visual field defects, four (50%) had optic atrophy on fundoscopy, three (37.5%) had endocrine symptoms and hormone reduction was found in four (50%).     

A Review of Primary Thyroid Lymphoma: Molecular Factors,Diagnosis and Management

Purpose/aim: To focus on current aspects of primary thyroid lymphoma (PTL), which is a rare clinical entity usually manifested by a rapidly growing mass in the neck that can cause pressure symptoms.

Materials and Methods: Relevant papers in PubMed published through June 2017 were selected to track updated information about PTL with an emphasis on diagnosis and novel therapeutic management.

Results: The most frequent cases include non-Hodgkin lymphoma derived from B-cells, mainly diffuse large B-cell lymphoma (DLBCL) followed by mucosa-associated lymphoid tissue (MALT) lymphoma or a mixed type. Other subtypes are less common. Lymphomas derived from T-cells and Hodgkin lymphomas are extremely rare. Hashimoto's autoimmune thyroiditis has been implicated as a risk factor for lymphoma. At the molecular level, the Wnt5a protein and its receptor Ror2 are involved in the course of the disease. Ultrasonography, fine needle aspiration (FNA) biopsy, and core or open biopsy combined with new diagnostic facilities contribute to an accurate diagnosis. An increased potential exists for a cure without the need for a radical surgical procedure. Modern chemoradiation therapy plus the monoclonal antibody rituximab, which acts against CD20, have limited the need for surgical interventions and provide an excellent outcome in most cases. However, some cases have resulted in treatment failure or recurrence.

Conclusions: A multidisciplinary approach must be used to define the management policy in each case. Future efforts by researchers are likely to be focused on the molecular level.     

内生性、中央型微小肾癌的诊断和治疗（附3例报告及文献复习）

目的：探讨内生性、中央型微小肾癌的定义、诊断和治疗,提高其诊治效果。方法：回顾性分析3例内生性、中央型微小肾癌患者的临床资料,根据B超、CT、MRI检查确立内生性、中央型微小肾癌（〈2．0cm）诊断。采用保留肾单位的肾肿瘤切除术,术中在B超引导下行肾部分切除术,结合文献资料进行讨论。结果：3例患者肾肿瘤均〈2．0cm,不突出肾表面,术中肾脏外观正常,在B超引导下进行肾肿瘤切除,保留了肾功能。术后患者生化、B超、CT随访6个月～5年,肾功能良好．无肿瘤复发。结论：内生性、中央型微小肾癌诊断主要依靠CT和MRI,首选治疗方法为保留肾单位的肾肿瘤切除术,其预后较好。