肾上腺外嗜铬细胞瘤七例报告

本文报告７例肾上腺外嗜铬细胞瘤的诊断和治疗，占同期嗜铬细胞瘤的１４．９％。持续性高血压或阵发性高血压５例，２例为无症就有功能型嗜铬细胞瘤且１例并发肾动脉狭窄。尿ＶＭＡ测定５例，４例阳性；Ｅ、ＮＥ测定均明显增高。定位诊断依靠Ｂ超、ＣＴ。全组手术切除（其中１例去外院），均经病理证实。３例恶性，２例多发，１例死亡。     

测定尿液儿茶酚胺对嗜铬细胞瘤诊断的价值

用荧光法测定３０例正常人、２５例嗜铬细胞瘤、１３例肾上腺肿瘤、１６例高血压患者尿儿茶酚胺含量，结果：嗜铬细胞瘤患者尿儿茶酚胺明显升高，与正常组及肾上腺肿瘤组、高血压组比较均有显著性差异（Ｐ均〈０．０１）。尿儿茶酚胺超过８８６．５ｎｍｏｌ／２４ｈ并伴有高血压者基本上可诊断为嗜铬细胞瘤。     

肾上腺肿瘤13例报告

从１９９０年１月—１９９５年７月收治肾上腺肿瘤１３例，肾上腺瘤６例，肾上腺嗜铬细胞瘤５例，肾上腺皮质腺癌２例。术前明确诊断的１１例，不明确的２例。不前Ｂ超、ＣＴ检查确诊为腺瘤和嗜铬细胞瘤最大切面的为１４．８×１０．４ｃｍ￣２，最小的为２×１．５ｃｍ￣２，均行手术切除，无一例术中死亡。肾上腺肿瘤无论大小均应尽早手术切除。     

儿童嗜铬细胞瘤13例临床分析

儿童嗜铬细胞瘤１３例临床分析第一附属医院儿科林致华，张丽娜，胡国祥关键词嗜铬细胞瘤；儿童嗜铬细胞瘤是小儿继发性高血压原因之一，占小儿慢性高血压的０．５％～１％。早期治疗可获痊愈。１临床资料男９例，女４例，年龄６～１５岁，１２～１４岁９例。发病至就诊时...     

膀胱嗜铬细胞瘤临床分析

报道５例膀胱嗜铬细胞瘤的诊断和。其中２例有高血压，３例有肉眼血尿，４例排尿时伴有心慌、胸闷、头痛、出汗等症状。尿儿茶酚胺的测定对嗜铬细胞瘤的定性诊断有很高的价值。膀胱镜检查对肿瘤的定位有重要的意义并可与其它膀胱肿瘤相鉴别。由于膀胱嗜铬细胞恶性倾率高，治疗上应作膀胱部分切除。恶性肿瘤的诊断需靠长期的临床随访。     

儿童嗜铬细胞瘤的诊断和围手术期处理

目的：研究儿童嗜铬细胞瘤的诊断和围手术期处理。方法;报２例儿童嗜铬细胞瘤,均男性,年龄７岁、７．５岁。主诉多钦、多尿、发热、头痛和视力障碍,体检发现高血压。２４小时ＶＭＡ和／或儿茶酚胺显著增高。腹部Ｂ超和Ｃ钎肿瘤切除。结果;２例术后均获随诊,血压正常。结论：嗜铬细胞瘤是儿童少见的肿瘤,２４小时尿ＶＭＡ和儿酚胺测定可定性。Ｂ超和ＣＴ可定位。手术切除疗效好。     

膀胱嗜铬细胞瘤1例

膀胱嗜铬细胞瘤１例秦皇岛市第一医院田宝乔得山张吉东关键词膀胱；嗜铬细胞瘤嗜铬细胞瘤主要发生在肾上腺髓质，生长在膀胱较少见。我院收治１例，报告如下：患者女，５２岁，主因无痛性肉眼血尿１天，于１９９５年１０月１８日入院。既往高血压病史５年，近２年排尿后有...     

膀胱嗜铬细胞瘤

报告５例膀胱嗜铬细胞用，３例良性，２例恶性。３例排尿时有典型高血压发作，２例排尿时血压正常。除了１例因肿瘤转移，另１例因诱导麻醉突然死亡外．余３例进行手术，术后效果满意。随访３～８年未见肿瘤复发。根据临床症状，膀胱嗜铬细胞瘤分为高血压型（又称功能型）和正常血压型（又分隐匿型和无功能型）。电子显微镜对肿瘤的超微结构研究显示：有功能的肿瘤分泌颗粒相当大，直径为２２０～２８０ｎｍ；无功能的肿瘤分泌颗粒比较小，直径仅为１００～１８０ｎｍ。为明确膀胱嗜铬细胞瘤的诊断和定位，分别对膀胱镜、ＣＴ、ＭＲＩ、Ｂ超和￣（１３１）Ｉ一ＭＩＢＧ等项检查的价值进行了评论。膀胱嗜铬细胞瘤以手术为主，但必须做好术前准备。最后对恶性膀胱嗜铬细胞瘤的临床表现和病理特征进行了描述。     

血浆去甲肾上腺素测定在嗜铬细胞瘤的诊断与定位诊断中的应用

本文报告以改良PNMT放射酶法,测定嗜铬细胞瘤、非嗜铬细胞瘤所致高血压患者及正常人各13、32、41例周围静脉和腔静脉血浆去甲肾上腺素(NE)含量,并探讨该方法对嗜铬细胞瘤的诊断和定位价值。12例嗜铬细胞瘤及13例非嗜铬细胞瘤所致高血压患者腔静脉分段取血血浆NE含量测定结果表明:①血浆NE含量在嗜铬细胞瘤患者明显升高,为     

肾上腺外嗜铬细胞瘤的诊断和治疗

为提高肾上腺外嗜铬细胞瘤的诊治水平，报导肾上腺嗜铬细胞瘤14例，占同期嗜铬细胞瘤的14．6％。临床表现主要为高血压。尿儿茶酚胺、香草基扁桃酸可作为定性诊断依据。定位诊断首选B超。本组均行手术死亡1例，肾上腺外嗜铬细胞瘤复发率和恶性倾向大，需长期密切随访。     

Fontan术后罕见并发症三例报道

回顾性分析3例Fontan术后比较罕见的并发症病例,其中2例为蛋白丢失性肠病,术前诊断1例为无脾综合征合并单心室和肺动脉狭窄,1例为功能性单心室合并肺动脉高压;另1例为塑型性支气管炎,术前诊断为纠正性大血管错位合并室间隔缺损和肺动脉狭窄。3例患儿Fontan术后至并发症出现的间隔时间分别为3周、3个月和5个月。术后死亡1例,失随访1例。Fontan术后腔静脉压力增高、心功能不全和高肺血管阻力,可能是蛋白丢失性肠病及塑型性支气管炎的发病原因。     

颅外阻塞性脑血管病的外科治疗

目的探讨颅外阻塞性脑血管病的外科治疗。方法回顾总结 1997～ 2 0 0 2年手术治疗颅外阻塞性脑血管病 34例的经验。其中 2 3例有不同程度的脑缺血症状 ,11例无任何脑缺血症状。病变部位在颈动脉分叉及颈动脉起始处 2 5例 ,其中 2 2例行单纯颈动脉内膜剥脱术 (carotidendarferecfomy ,CEA) ,3例行CEA 补片 ;病变在锁骨下动脉起始处 5例 ,其中 4例行锁骨下动脉锁骨下动脉搭桥 ,1例行锁骨下动脉颈总动脉搭桥术 ;颈总动脉闭塞 4例 ,均行锁骨下动脉颈总动脉搭桥术。结果 32例术后恢复良好 ,1例术后第 4天并发缺血性脑卒中 ,1例因术后第 2天高血压脑出血死亡。结论外科手术是预防和治疗颅外阻塞性脑血管病的有效方法。     

The Extrarenal Manifestations of Hypernephroma

The extrarenal manifestations of hypernephroma in 34 medical patients are described, and the literature on this subject is reviewed. One case presented with hematuria and 11 other cases with metastases. Presentation was not obviously related to metastases in 22 patients. Eight were first seen because of fever or general weakness. Vascular disturbances in six included hypertension, thrombophlebitis, inferior vena caval obstruction and varicocele. Four patients had gastrointestinal complaints; one had hypercalcemia and another musculoskeletal symptoms. Two cases had neurological syndromes, one of which proved to be due to metastases. The overall incidence of systemic features was greater and included anemia, eosinophilia, a leukemoid reaction and thrombocytosis. Polycythemia, amyloidosis and hyponatremia were not encountered. Urographic procedures were performed in half of the patients, most of whom had an abdominal mass. Calcium was visible radiologically in the tumour in five cases. The diagnosis was not made in 19 and was an unexpected finding at autopsy in 10. Appreciation of the extrarenal manifestations of hypernephroma might lead to earlier diagnosis.     

降压药物对原发性高血压患者运动血压的影响

目的观察降压药物对原发性高血压患者运动血压变化的影响。方法126例高血压患者和40例血压正常者作平板运动试验,观察运动血压、心率等指标的变化。在126例高血压患者中,应用降压药物的98例,其中静息血压控制良好者35例,未控制者63例;未应用药物控制者28例,分别比较这些患者的运动血压水平变化。结果用药物控制的高血压患者发生运动高血压的比例(49．2％)与未用药物控制者(42．8％)相仿;静息血压控制良好者运动血压水平低于控制不良者。结论静息血压控制不良的高血压患者发生运动高血压的比率较高。平板运动试验可作为药物降压效果的评估手段之一。     

Abdominal suture proctopexy for complete prolapse of rectum.

Eighteen patients, 13 males and 5 females, with complete rectal prolapse have been treated by suture proctopexy during the period 1987-1989 with no operative mortality and very little morbidity. There was only one case of recurrence during a 3-year follow-up for which a repeat identical procedure was successful. There was some disturbance in faecal continence pre-operatively in 14 cases, of whom, 13 cases were improved by suture proctopexy. There was no significant change in bowel habit postoperatively, with the exception of 2 patients who had constipation postoperatively but one reverted to normal on re-education of bowel habit. All the patients had normal urinary and sexual function. This relatively simple procedure was well tolerated by the patients.     

肝泡状棘球蚴病引起的门静脉高压症(附12例临床病例报告)

作者报道自1981年至1990年收治的肝泡状棘球蚴病引起的门静脉高压症12例,并对其临床表现、病理特点、预防和治疗进行了讨论。作者认为早期诊断、及时治疗原发病是预防这一并发症的首要措施;手术切除主要病变加有效的化疗对提高泡状棘球蚴病的治愈率,预防和治疗并发症是有效可行的治疗方法。     

39例胼胝体梗死的MRI表现分析

[背景]分析胼胝体梗死的MRI表现特点.[病例报告]39例胼胝体梗死患者中有高血压病史者为35例,糖尿病者为9例,其中合并高血压病史为5例;梗死发生于胼胝体膝部者为5例,干部者为27例,压部者为7例,梗死病灶2个及以上者为15例;病灶大小为2 mm×3 mm~8 mm×17 mm.[讨论]MRI扫描可有效且准确地显示胼胝体梗死的部位、大小及合并其他部位的病灶.     

自体肾移植四例的长期随访

对4例因肾动脉狭窄引起恶性高血压妇女的自体肾脏移植进行了3年以上的随访,其中两例已8年之久,血压全部恢复到正常范围,并且排泄性肾盂造影显示了正常功能和解剖形态。2例女青年术后结婚,并且无任何并发病足月生了孩子。2例术后3个月高血压复发,其中1例动脉造影显示动脉吻合处狭窄,可是术后6～8个月血压又全恢复了正常。     

黏多糖病Ⅱ型患者的心脏表现

目的总结黏多糖病Ⅱ型(MPSⅡ型)患者心脏改变的临床特点。方法收集2000年1月一2011年4月确诊的MPSⅡ型患者14例的临床资料,分析心电图(ECG)和超声心动图检查结果。结果 14例患者均为男性,发病年龄1～8(3.8±2.5)岁,明确诊断并完善心脏检查时年龄(9.3±4.6)岁,心脏查体10例(71.4%)有阳性体征,其中9例可闻及心前区杂音。4例(28.6%)心电图不正常,表现为一度房室传导阻滞、右束支传导阻滞或心室肥厚。行超声心动图检查12例,结果异常11例(91.7%),均表现为瓣膜增厚,其中4例(33.3%)各瓣膜均有增厚,6例(50.0%)为主动脉瓣三个瓣叶及二尖瓣前后叶增厚,1例(8.3%)为先天性主动脉瓣二叶瓣畸形伴瓣叶增厚。2例(16.7%)出现重度肺动脉高压,其中1例伴有中等量心包积液。结论 MPSⅡ型患者多数合并心脏损害,主要表现为瓣膜增厚、粘连及功能异常,少部分出现心肌病变、肺动脉高压、房室传导阻滞等异常,其病程隐匿,需严密随诊。     

Renal lesions in leprosy amongst north Indian patients.

Sixty consecutive patients with leprosy were investigated for renal involvement. Clinically overt renal disease was present in 4 patients; 3 presented with a nephrotic state and one patient with progressive renal failure. Urinalysis showed daily protein loss ranging from 0.4 to 8.9 g in 8 patients and microscopic haematuria in 4 cases. Elevated levels of blood urea and creatinine were seen only in one patient with diffuse proliferative glomerulonephritis. Of the 36 patients in whom distal tubular functions were evaluated, concentration and/or acidification defects were detected in 9 patients (25%). Renal histology revealed no abnormality in any of these patients. Serum C3 levels were decreased in 5 patients with lepromatous leprosy and 3 patients with borderline leprosy. Histological evidence of renal involvement was detected in 9 patients (15%). Amyloid deposits were seen in 3 (5%) patients of whom 2 had lepromatous leprosy and one had tuberculoid leprosy with chronic trophic ulcers. Mesangial proliferative lesions were seen in 5 (8.3%) and diffuse proliferative lesions (with crescents in more than 70% of glomeruli) in one patient. All of them had lepromatous leprosy. Three of the 5 patients with mesangial proliferative glomerulonephritis had erythema nodosum leprosum at the time of biopsy. Immunofluorescence studies revealed granular deposits of IgA, IgM and C3 in one patient with mesangial proliferation and IgA/IgM with or without C3 in 3 more patients in whom renal histology was normal. Glomerulonephritis associated with leprosy appears to be immune mediated but confirmation requires identification of lepra antigen in the glomerular immune complex deposits.