膈肌结核瘤1例

患者男性,24岁,因低热、咳嗽、盗汗、左侧胸痛1年6个月,按渗出性胸膜炎治疗无效。近半个月来,自感左侧胸部呈持续性针扎样疼痛,疼痛不向它处放射、呼吸、咳嗽时加重,左季肋部顶压感及胀痛、伴盗汗、X线检查:左侧膈肌顶部有一圆形阴影,以膈肌包虫收入外科。查体:慢性病容,体质消瘦,左侧胸部呼吸运动减弱,左肺底活动3cm,侧季肋部叩击痛,实验室检查,ESR4mm/小时,卡松尼试验(一),B超检查提示:脾、膈间占位性病变。CT检查示:脾、膈区软组织炎性肿块。 术中所见:于1994年3月开胸探查,术中见肺与胸膜广泛粘连,膈肌顶部可触及3.5cm×4cm×3cm~3大小肿块、质硬、边缘不规则、表面节结状、与侧胸壁第8、9、10肋胸膜粘连,肿块顶部与肺组织粘连、融合,故分离肿块与肺组织粘     

右侧胸腹交界区病变的MDCT表现及其解剖、病理基础

为明确右下胸部、膈肌和右上腹部疾病累及右侧胸腹交界区的多层螺旋CT(MDCT)表现及解剖、病理基础,通过观察3例尸体横断面、3例矢状面标本胸腹交界区结构的位置、形态特征,并结合右侧胸腹交界区疾病69例的MDCT表现,阐明其影像学表现与解剖、病理的相关性,发现断面解剖上:右肺韧带位于下肺静脉下方,内侧附着于食管,外缘止于右肺下叶内侧表面;冠状韧带内侧与镰状韧带相延续,外侧上下层融合成右三角韧带,上下层之间为肝裸区。螺旋CT图像上,同时胸腹积液50例,右肺韧带将胸水在内侧分隔成前、后两部分,右上腹腔积液多分布于肝周间隙;5例右下肺癌向下累及膈胸膜、膈肌和上腹部结构;5例肝右叶癌向上累及膈下腹膜、膈肌脚及右下肺;1例右肾上腺癌伴膈肌转移;8例炎性病变均涉及到右下胸腔和右上腹部。该区域疾病的扩散途径主要包括直接浸润、血行和淋巴道的播散,并且右侧胸腹交界区解剖特点影响该区域疾病的局部、扩散和相互通连的影像表现。     

系统性红斑狼疮的胸部X线表现研究(附46例报告)

目的探讨系统性红斑狼疮的胸部X线表现,提高对红斑狼疮胸部X线的诊断水平。方法对46例经临床及病理证实的系统性红癍狼疮患者的胸部X线表现进行分析研究。结果约86．9％的系统性红斑狼疮患者胸部X线异常,多数显示肺间质改变,部分间或有肺实质改变;约50％患者累及胸膜;约66％病人心影有异常改变。结论系统性红斑狼疮较易侵及肺部血管及心血管,胸部X线表现形式多样化,了解并掌握系统性红斑狼疮常见胸部X线表现。为临床诊断和治疗提供重要价值。     

电视胸腔镜手术在胸部疾病诊断和治疗中应用的体会

目的　探讨电视胸腔镜手术 (VATS )在胸部疾病诊断和治疗中的作用。方法　 1996年 9月以来选择性地开展了电视胸腔镜手术 6 6例 ,其中肺大疱及自发性气胸 32例、肺结核球和结核性空洞 14例、肺恶性肿瘤 5例、肺良性肿瘤 5例、肺包虫囊肿 2例及纵隔肿瘤 3例 ,肺动静脉瘘、胸膜脂肪瘤、恶性胸膜间皮瘤、局限性结核性脓胸、外伤性膈疝各 1例。结果　VATS手术创伤小、失血量少、手术时间短、病人痛苦轻、恢复快、缩短住院日、无严重并发症。结论　VATS诊断和治疗胸部部分疾病是一种安全、有效、微创的手术方法。     

肺转移瘤的X线-临床分型研究

目的为提高对肺部转移性肿瘤的认识和X线诊断水平.方法对102例经临床病理证实为肺转移瘤的X线特征进行回顾性分析.结果根据其X线表现可分为7型：粟粒微小结节型19例（18.6％）;多发结节团块型55例（53.9％）;炎症型3例;肺门纵隔型3例;胸膜胸水型10例（9.8％）;单发结节团块型10例(9.8%);癌性淋巴管炎型2例.结论传统X线与胸部CT检查均是诊断肺部转移瘤的主要方法,但对小于5mm的病灶的检出率及对肺门纵隔型与胸膜胸水型的检查,后者比前者更佳.     

肺转移瘤的X线—临床分型研究

目的 为提高对肺部转移性肿瘤的认识和X线诊断水平，方法 对102例经临床病理证实为肺转移瘤的X线特征进行回顾性分析。结果 根据其X线表现可分为7型，粟粒微小结节型19例（18.6%)；多发结节团块型55例（53.9%)；炎症型3例；肺门纵隔型3例；胸膜胸水型10例（9.8%)；单发结节团块型10例（9.8%)；癌性淋巴管炎型2例。结论 传统X陛下与胸部CT检查均是诊断肺部转移瘤的主要方法，但对小于5mm的病灶的检出率及对肺北京时间纵隔型与胸膜胸水型的检查，后者比前者列佳。     

肺内支气管动脉及其与肺血管的吻合

在解剖显微镜下放大3～40倍,观察了30例(成人与儿童)正常和病变肺的肺内支气管动脉及其与肺血管的吻合。支气管动脉伴随支气管呈弯曲、蛇行经过,于支气管分叉的前方或后方分支,常以2支沿支气管支分布,呈对向排列,在支气管外膜中形成动脉网。小支穿支气管壁,在粘膜下层亦形成动脉网。支气管动脉的纵隔面胸膜支与叶间胸膜支位于肺胸膜下,与支气管树分离,在肺外周部管径较粗。在支气管壁与肺胸膜中,支气管动脉与肺动、静脉间存在毛细管前的端一端吻合或端一侧吻合。9例胸膜粘连处的新生胸膜支(发自肋间动脉、最上肋间动脉、心包膈动脉或胸廓内动脉)通过肺胸膜动脉网与支气管动脉吻合,以加强肺病变区的血液供应。此外,对支气管动脉在肺内的经过、分布及其与肺血管吻合的生理功能进行了讨论。     

钝性创伤性膈疝12例诊断与治疗

目的：探讨钝性创伤性膈疝的诊断治疗方法。方法：2008年9月-2011年12月我科收治钝性创伤性膈疝12例,对其临床资料进行旧顾性分析。结果：本组12例,术前胸部X线片检查确诊3例,胸部Crr检查确诊7例,手术中探查确诊2例。12例均手术修复破损膈肌,还纳移位脏器,其中1例合并有左下肺实变,予以左下肺叶切除;2例因降结肠、结肠脾曲嵌顿坏死,行坏死结肠切除,结肠外置。术后肺部感染2例,所有患者切口均愈合良好,均治愈出院。术后随访无复发,无一例死亡。结论：钝性创伤性膈疝可通过详细了解受伤原因、部位,全面细致的体格检查,以及X线、胸部CT等辅助检查及早明确诊断。钝性创伤性膈疝一旦确诊,应立即手术治疗,以修复破损膈肌,还纳移位脏器,减轻胸腔压迫,恢复循环、呼吸和消化功能。     

外伤性膈疝18例分析

目的进一步提高对外伤性膈疝的诊治水平.方法对外伤性膈疝18例进行回顾性分析.结果单纯性腹部挤压伤6例;单纯性胸部挤压伤2例;复合性损伤10例.以胃脾疝入左胸腔多见(12例);肝脏疝入右胸腔6例.伤后全部病例即有不同程度的呼吸困难、胸腹痛、腹膜刺激征,胸部X线、膈肌B超异常改变等表现.全组治愈.结论胸腹部挤压伤有上述典型表现,提示膈肌破裂、膈疝.胃管造影、X线及B超检查为诊断的重要手段,及早手术治疗,有利康复.     

成人原发型肺结核的X线胸片表现探讨

目的：对成人原发型肺结核的X线胸片表现进行探讨。方法选取从2011年5月~2014年5月诊治的36例原发型肺结核患者,分析其X线胸片表现。结果本组患者中,4例为原发综合征肺结核,X线以边界模糊云絮状影为主要表现。胸内淋巴结结核8例,在初诊时X线表现为椭圆形或者是圆形结节状影,纵隔同内缘相连接,外缘呈现为分叶状或者是半圆形突出,边界较为清晰。7例采取胸部CT平扫,在左上肺可以发现胸膜粘连与纤维条索影。结论通过对胸部X线表现与肺结核临床表现可以看出,不同类型肺结核的X线表现有其一定的独特性。部分肺结核患者临床X线表现处于正常水平,因此大多数肺结核诊断主要是参照X线表现与临床表现进行确诊。在不同时间要注意动态观察,这对于鉴别诊断有着重要的作用。     

Structure,blood supply,and lymphatic vessels of the sheep's visceral pleura

We investigated the morphology of the visceral pleura of 36 sheep, using macroscopic, histologic, and ultrastructural approaches to quantify regional pleural thickness, blood supply, and lymphatic drainage, including the pulmonary ligament and hilar lymphatic distributions. Pleural thickness increased caudally and dorsally, such that the costal pleura of the caudal lobes had a mean minimum pleural thickness of 83 μm. The blood supply to the entire visceral pleura came exclusively from the bronchial arteries. Lymph vessels formed an extensive plexus throughout the serous membrane of all lobes. Trunk lymphatics (> 100 μm diameter) had a density of about 2/cm of pleural length on all lobar surfaces except for the cranial and middle lobes, where their density on the costal surfaces was ≤ 1/cm. Pleural trunk lymphatics coursed to the pulmonary ligaments and to the hilum on their way to regional lymph nodes. At the hilum they anastomose with intrapulmonary lymphatic trunks. The principal lymph nodes to receive pulmonary lymph were the caudal mediastinal node and tracheobronchial nodes. The visceral pleura of sheep is thick, showing considerable regional diversity in morphology.     

Vagal nerve endings in visceral pleura and triangular ligaments of the rat lung

The inner thoracic cavity is lined by the parietal pleura, and the lung lobes are covered by the visceral pleura. The parietal and visceral plurae form the pleural cavity that has negative pressure within to enable normal respiration. The lung tissues are bilaterally innervated by vagal and spinal nerves, including sensory and motor components. This complicated innervation pattern has made it difficult to discern the vagal vs. spinal processes in the pulmonary visceral pleura. With and without vagotomy, we identified vagal nerve fibres and endings distributed extensively in the visceral pleura (‘P’‐type nerve endings) and triangular ligaments (‘L’‐type nerve endings) by injecting wheat germ agglutinin‐horseradish peroxidase as a tracer into the nucleus of solitary tract or nodose ganglion of male Sprague–Dawley rats. We found the hilar and non‐hilar vagal pulmonary pleural innervation pathways. In the hilar pathway, vagal sub‐branches enter the hilum and follow the pleural sheet to give off the terminal arborizations. In the non‐hilar pathway, vagal sub‐branches run caudally along the oesophagus and either directly enter the ventral‐middle‐mediastinal left lobe or follow the triangular ligaments to enter the left and inferior lobe. Both vagi innervate: (i) the superior, middle and accessory lobes on the ventral surfaces that face the heart; (ii) the dorsal‐rostral superior lobe; (iii) the dorsal‐caudal left lobe; and (iv) the left triangular ligament. Innervated only by the left vagus is: (i) the ventral‐rostral and dorsal‐rostral left lobe via the hilar pathway; (ii) the ventral‐middle‐mediastinal left lobe and the dorsal accessory lobe that face the left lobe via the non‐hilar pathway; and (iii) the ventral‐rostral inferior lobe that faces the heart. Innervated only by the right vagus, via the non‐hilar pathway, is: (i) the inferior (ventral and dorsal) and left (ventral only) lobe in the area near the triangular ligament; (ii) the dorsal‐middle‐mediastinal left lobe; and (iii) the right triangular ligament. Other regions innervated with unknown vagal pathways include: (i) the middle lobe that faces the superior and inferior lobe; (ii) the rostral‐mediastinal inferior lobe that faces the middle lobe; and (iii) the ventral accessory lobe that faces the diaphragm. Our study demonstrated that most areas that face the dorsal thoracic cavity have no vagal innervation, whereas the interlobar and heart‐facing areas are bilaterally or unilaterally innervated with a left‐rostral vs. right‐caudal lateralized innervation pattern. This innervation pattern may account for the fact that the respiratory regulation in rats has a lateralized right‐side dominant pattern.     

Lymphatic drainage of the diaphragmatic pleura to the peritracheobronchial lymph nodes

Non-small cell lung cancer invading the visceral pleura is characterized by a particular richness of mediastinal lymph node (LN) metastases. This may be due to subpleural lymphatic drainage of tumor cells. The aim of this study was to determine mediastinal LN lymphatic drainage from the diaphragmatic pleura. Subpleural lymphatics of 30 adult cadavers and 12 fetuses were injected with a modified Gerota's medium to permit lymph vessels and nodes to be visualized and then dissected. Each stage of the dissection was described and photographed. In 32 cadavers mediastinal visceral LN chains were injected, of which 29 originated from the mediolateral portion of the diaphragm. On the right, injections (n=16) demonstrated lymph vessels (n=20) ascending directly along the inferior pulmonary ligaments (n=8) or after having encircled the inferior vena cava (n=8), and lymph vessels passing between the pulmonary veins (n=4); all these lymphatics were connected to the intertracheobronchial nodes and some ascended along the tracheobronchial LN chains in the upper mediastinum. On the left, injections (n=13) demonstrated lymph vessels (n=16) ascending along the inferior pulmonary ligament (n=5) or along the esophagus (n=11) and connecting to the intertracheobronchial nodes, some of which ascended further in the upper mediastinum (left paratracheobronchial LN chain). These mediastinal LN chains are the same as those that receive lymph from the pulmonary segments. Lymphatic drainage of the diaphragmatic pleura may add to that of the lung involved in cancer and potentially increases lymphatic spread of tumor cells.     

氧化钇-羟基磷灰石骨修复材料的研究

羟基磷灰石在临床上广泛应用于骨缺损的修复，为提高其骨结合性和阻射性，本研究在合成羟基磷灰石的过程中，将活性高、阻射性强的氧化钇按不同比例加入进行化学合成，得到一种生物。相容性好、阻射性强、价格便宜的生物材料。     

Pathogenic effects of asbestos.

The enormous increase in the use of asbestos during this century has necessitated the intensive study of its pathogenic effects. The occurrence of pulmonary parenchymal and pleural fibrosis and an increased prevalence of pulmonary and gastrointestinal carcinoma and of pleural and peritoneal mesothelioma have been established. A relationship, also, to laryngeal carcinoma is probable. Mesothelioma has been associated with indirect occupational, domestic, and neighborhood exposure, and the possibility of a similar correlation of pulmonary carcinoma with low exposure has been suggested. Pulmonary fibrosis and pleural plaques have been demonstrated under these circumstances. The physical characteristics of the asbestos fiber appear to be the principal factors in its carcinogenic action. The ability of fine, short fibers, especially fragmented chrysotile, to reach the pleura would appear to account for many of the pathogenetic and anatomical features of asbestos-related disease.     

Lymphangiomyomatosis: A report of three cases treated with tamoxifen

Summary Three cases are reported of lymphangiomyomatosis with pulmonary and abdominal manifestations. Two had a chylous pleura effusion, while the third presented a retroperitoneal manifestation, which was completely resectable. Antiestrogen therapy with tamoxifen was administered in all three cases. Two patients died of pulmonary progression after 4 months of therapy. The third is still alive, with stable disease for more than 6 years, and has been receiving tamoxifen for 66 months. These observations indicate that antiestrogen treatment may be as effective as oophorectomy when started at an early stage of the disease.     

用迭代法重建医用加速器光子束等效能谱

我们设计了接近实际形状的变型高斯分布作初始能谱，重建医用直线加速器光子束穿透等效能谱。与过去的方法相比，该法重建过程简单，逼近真谱速度快，逼近程度高，各参数调节能力强，计算量小，测量要求低。我们讨论了用变形高斯分布作初始能谱的重建本领，并与用三角形初始能谱重建结果作了比较。我们重建出ＳＬ７５／２０型医用电子直线加速器８ＭＶ光子束中轴的穿透等效能谱。     

Complexation between hydrogensulfated fullerenol and poly(4‐vinylpyridine)

A fullerene (C₆₀) derivative, hydrogensulfated fullerenol, has been complexed with poly(4‐vinylpyridine) (P4VPy) through a supramolecular approach. The complexes are formed by mixing the N,N‐dimethylformamide (DMF) solutions of P4VPy and hydrogensulfated fullerenol with multiple —OSO₃H groups. Glass transition temperatures can not be detected in all complexes due to the strong interaction between the two components. Both Fourier transform infrared spectroscopy and X‐ray photoelectron spectroscopy demonstrated the ionic nature of the interaction in the complexes.     

A solitary fibrous tumor in the broad ligament of the uterus

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor that occurs preferentially in the pleura. Although it has been described at some extrathoracic sites, its occurrence in the female genital tract is extremely rare. We are the first to report on an unusual case of a large (14cm in the largest diameter) SFT localized in the broad ligament of the uterus in a 50-year-old woman. The patient underwent surgical tumor extirpation and has remained well without any sign of local tumor recurrence after 6 years of follow-up. We discuss the clinical aspects, the gross macroscopic appearance, the histologic findings, and the differential diagnosis, and provide a review of the literature.     

用纹理分析对骨质疏松作定量评估的研究

我们在对骨X线图像骨小梁纹理进行相干映射增强、经传递函数修正的骨X线图像二维谱估计以及骨X线图像纹理分形特征分析的基础上，提出了用纹理分析对正常的骨结构和中等程度骨质疏松作定量评估。选择骨小梁模式的3项客观特征组成一个对这两类骨结构自动分类的特征集。这个特征集从16幅骨X一图像中提取。在特征空间中利用欧拉落数，将获得的每类骨结构的特征集的中心定义为该类骨结构的诊断标准。对每一幅骨X线图像，在特征空间中计算其特征到两个标准的距离来提供对骨质疏松程度的客观评价。利用我们提出的分类标准对10幅骨X线图像进行机器分类，分类结果表明了本方法有实用的潜在价值，并提出了今后建立定量诊断标准的建议。