Primary Adenocarcinoma of the Epididymis： a Case Report and Literature Review

Objective: To promote the accuracy of diagnosis and the efficiency of treatment of primary epididyrnal adenocarcinoma. Methods: A 57 years old man was admitted in April 2000 with the right epididyrnal mass. We treated him as right epididyrnal neoplasm according to his symptom, physical examination, diagnostic therapy and specific carcinoernbryonic antigen about epididymis. Results: The patient suffered a right orchiectomy by transscrotal approach. The pathologic analysis displayed a right adenocarcinoma of the epididymis, grade Ⅱ-Ⅲ with a positive surgical margin of right spermatic cord, and immunohistochemical PSA staining was negative. Then a upper right spermatic cord excision and biopsy of the lymph nodes in pelvic cavity was performed. Intraoperatively, the metastasis disease was found during inguinal exploration. Metastasis or invaded adenocarcinoma was found in right sperrnatic cord and fibrous tissue based on pathologic examination. No intravascular metastasis was found. No furthermore treatment was given and the patient died half an year after diagnosis. Conclusion: The adenocarcinoma of the epididymis is easily misdiagnosed to be the tuberculosis of the epididymis and chronic epididymitis, and usually the neoplasm was poorly differentiated. The prognosis of these cases are very poor, and usually die in a short term.     

Primary Sjogren＇s Syndrome Accompanied by Intestinal Obstruction： a Case Report and Literature Review

SJGREN’S syndrome (SS) is a chronic inflammatory autoimmune disease characterized by the infiltration of lymphocytes and plasma cells in exocrine glands, especially salivary and lacrimal gland interstitium. The clinical manifestations of SS are complex. When the digestive system is involved, the     

Squamous Cell Carcinoma of Small Intestine：a Case Report

NEOPLASMS derive from small intestine are rareand most cases are adenocarcinomas andcarcinoid.1 Squamous cell carcinoma of smallintestine is even rarer and only few casesreported in literature.1 In this article, we report a case of a68-year-old male who underwent a laparotomy due toperforation of the small intestine and was diagnosed withsquamous cell carcinoma of the small intestine.     

Multiple Myeloma Mimicking Spondyloarthritis：a Case Report

MULTIPLE myeloma （MM） is a hematologicmalignancy of differentiated plasma cells thataccumulate and proliferate in the bonemarrow. MM patients often develop bonedisease that results in severe bone pain, osteolytic lesions,and pathologic fractures,1 presenting with unexplainedbackache or bone pain in the long bones, ribs, skull, orpelvis.2 However, the low backache mimicking spondyloarthritisin MM is uncommon during clinical practice. Spondyloarthritis isa chronic systemic inflammatory disorder of the axialskeleton, mainly affecting the sacroiliac joint and spinecausing low backache.3 Here we report a patient with MMwhich was initially misdiagnosed and treated asspondyloarthritis.     

Recurrent Seizures Manifestations in a Case of Congenital Hypoparathyroidism＇ a Case Report

HYPOPARATHYROIDISM is characterized by hypocalcemia, hyperphosphatemia and low or inappropriately normal levels of parathyroid hormone （PTH）. PTH is a key calcium regulatinghormone essential for calcium homeostasis, vitamin D-dependent calcium absorption, renal calcium reabsorption and renal phosphate clearance. Hypoparathyroidism may be due to congenital or acquired disorders. Causes include autoimmune diseases, genetic abnormalities, destruction or infiltrative disorders of the parathyroid glands.     

Refractory and Active Ulcerative Colitis Complicated by Venous Thrombosis：a Case Report

ULCERATIVE colitis is a chronic inflammatorydisease characterized by diffuse mucosalinflammation involving the rectum and extendingproximally to involve all or part of the colon. Astep-up approach for medical therapy is routinely applied,from 5-aminosalicylic acid （ASA） compounds, corticosteroids,immunomodulators, and biologics.1 Thrombosis, mainlyvenous, is a rare and well-recognized extra-intestinalmanifestation of inflammatory bowel disease.2 In thisarticle, we report the use of thrombolytic and antithrombotictherapy for the venous thrombosis in a 55-year-old malepatient with refractory and active ulcerative colitis withexcellent outcome.     

Accuracy of Narcotrend Index in Monitoring Depth of Anesthesia in Diabetics：a Case Report

NARCOTREND index （NI） is based on studies ofnormal human brain electrical data. It uses anordinary electrode to collect and analysis brainelectrical signals immediately at any positionof the head, to display the state of consciousness and depthof anesthesia of patients on the touch screen afterautomatic analysis and classification, so as to guide doseadjustment of anesthetics. NI may make the consciousnessand depth of anesthesia monitoring safe, simple, accurate,and economic. It is important that NI is more accurate thanclassical electroencephalographic variables.^1 Weber et al2believed that the NI was an objective and true index in theevaluation of propofol sedation in children.     

Combined Therapy of Operation and Radiation in Primary Liver Cancer

Combined therapy of operation and radiation was carried out in 22patients with primary liver cancer in our hospital.All the patients weremales,ranging from 15-69 yr of age with an average of 44.5 yr.His-tological diagnosis was hepatocellular carcinoma in 21 cases andcholangioearcinoma 1 case.17(77.3％)patients were associated withliver cirrhosis,and 19(86.4％)patients had positive AFP bycounterimmunoelectrophoretic method.Clinically,6 patients were in stageⅠ,11 in stage Ⅱ and 5 in stage Ⅲ.Liver resection was performed on 17patients(5 local resections,5 right hemihepateetomies,2 left laterallobectomies,2 left hemihepatectomies,2 total right hepatectomies,and1 left medial Iobectomy)and palliative operation on the other 5 patients(4 hepatic artery ligations or operative embolizations and 1 hepaticartery infusion).For radiotherapy either local or perative whole-liverradiation with ~(60)Co was applied.Up to May 1983,19 patients who had been followed up had survivedfor more than 6 months.The survival rates at 1,2,3,4 years aftertreatment were 78.9％,66.7％,64.3％ and 44.4％ respectively with amedian survival duration of 36 months.Data have shown that the encou-raging results of this method are better than those of only liverresection or only radiotherapy at present.     

Hyperglycemia and Lactic Acidosis after Ingestion of a Lethal Dose of Slow-Release Nidedipine——Case Report

We present the case of a 23-year-old woman patient hospitalized 8 hours after ingesting of 300 tablets of 10 mg slow-release nifedipine （3000 rag） in a suicide attempt, showing-collapse, hyperglycemia, lactic acidosis. In evolution, anuria and acute pulmonary edema emerged. Under supported treatment of the vital functions, fluid resuscitation associated with amine pressors, administration of large doses of calcium gluconate and euglycemic insulin therapy, the evolution is in the end favorable.     

Case Report： Treatment of Canary Pox with Orally Administration of Acyclovir

Objective： In this study, the effects of acyclovir on treatment of canary pox were examined. Two Canaries （one live ＆ one dead） were referred to Avian Medicine Clinic. At post mortem examination, pox like lesions were observed in mouth, pharynx, larynx and upper part of trachea. In examination of the live bird, clinical signs such as depression, dyspnea, gasping were seen. Acyclovir is phosphorylated by viral thymidine kinase and inhibits viral DNA polymerase. The live bird was treated with acyclovir and was inspected every day. Methods： The live canary was treated with acyclovir at 80 mg/kg each 6hr/day orally for 10 days and was inspected every day. Results： The apetite of bird was improved gradually. After 10 days, all of clinical signs and gross lesion were disappear. Conclusions： Canary pox will be treated by acyclovir at 80 mg/kg each 6hr/day orally for 10 days.     

肘关节镜下关节清理术治疗肘关节滑膜软骨瘤病的疗效观察

目的观察肘关节镜下关节清理术治疗肘关节滑膜软骨瘤病的疗效。方法 12例肘关节滑膜软骨瘤病患者术前均有不同程度疼痛及活动受限。术中均采用肘关节镜下关节清理术,清除关节内游离体及病变滑膜,术后随访6～24个月,采用Mayo肘关节评分作为疗效评定的标准,观察所有肘关节滑膜软骨瘤病患者治疗前后肘关节评分及肘关节屈曲角度的改善情况。结果 12例患者随访6～24月（平均15月）。肘关节平均伸屈活动范围从术前的79.6°±10.3°提高到术后的128.4°±12.5°。肘关节疼痛、肿胀症状减轻。Mayo肘关节评分由术前的55.4±13.1分提高到术后的89.2±11.7分。7例患者非常满意,4例满意,1例不满意,满意率为91.67%。结论肘关节镜创伤小、并发症少、术后恢复快、功能改善显著,是治疗肘关节滑膜软骨瘤病的有效方法。     

伴关节盘穿孔的颞下颌关节滑膜软骨瘤1例报告及文献复习

目的：分析伴关节盘穿孔的颞下颌关节滑膜软骨瘤（TMJSC）患者的临床表现、发病机制、辅助检查、鉴别诊断和治疗方法,为TMJSC患者的诊疗提供依据。方法：收集1例TMJSC患者的临床资料,并分析诊治过程,并进行相关文献复习。结果：患者,女性,53岁,因发现右侧颞下颌关节（TMJ）偶有压痛1年余入院。计算机断层摄影（CT）检查显示上颌窦壁及关节周围改变,磁共振成像（MRI）可见关节腔弥漫性结节状低、等异常信号,关节腔液体信号影增多,关节间隙增宽。对患者采取开放性手术治疗,切除游离体和病变滑膜,手术顺利完成,术后组织病理学检查结果为滑膜软骨瘤（SC）。随访6个月未见复发。结论：TMJSC诊断应采用组织病理学检测结合CT和MRI辅助检查,手术治疗是有效的治疗手段,病理诊断为诊断TMJSC的金标准。     

膝关节“隐匿性”滑膜软骨瘤病的关节镜诊治

目的探讨临床症状、体征和影像学表现不典型的膝关节"隐匿性"滑膜软骨瘤病的关节镜诊断和治疗效果。方法 2006年11月至2009年10月本科关节镜诊治4例"隐匿性"膝关节滑膜软骨瘤病,临床表现为膝关节肿胀、疼痛,X线平片和磁共振检查未发现游离体,关节镜检查确诊,并行关节镜下滑膜软骨瘤摘除和病变滑膜切除术。结果膝关节"隐匿性"滑膜软骨瘤病表现为大量微小软骨游离体存在于关节腔、或少量微小软骨游离体局限于滑膜组织内。4例患者均经病理检查证实,全部获得随访,平均随访14个月,所有病例术后功能良好,未见复发,仅1例伴软骨损伤患者残留膝关节轻度疼痛。结论膝关节"隐匿性"滑膜软骨瘤病临床表现不典型,X线平片和磁共振检查常不能确定诊断,关节镜是该病惟一可靠和有效诊断及治疗方法。     

颞下颌关节滑膜软骨瘤病的临床分析

本研究收集2011年8月~2014年8月间于我院诊治的颞下颌关节滑膜软骨瘤病患者5例,所有患者术前影像学检查协助临床诊断和病灶范围,对收集的病例采取手术治疗方案,术后经病理诊断均明确为滑膜软骨瘤病.分析其临床表现、影像特征、诊断及治疗结果,5例患者均有关节区疼痛的症状,其中3例开口受限、3例关节区肿胀、5例患者X线平片见关节间隙增宽、5例影像学检查发现有关节内占位性改变.采取开放性关节手术方案,所有手术顺利完成,术后影像学检查显示术区无病灶残留.关于颞下颌关节滑膜软骨瘤病在临床上的研究极为罕见,文献报道极少,临床表现并不明显,在诊断过程中常常需结合影像学、关节镜和病理学等检查,其中游离体是该疾病的重要特征,且多发于关节上腔.颞下颌关节滑膜软骨瘤病需行手术治疗,临床常用手术方案为关节切开后行游离体和受累滑膜切除术.     

原发性滑膜软骨瘤病19例手术治疗及随访

目的：探讨大切口切开手术治疗原发性滑膜软骨瘤病的疗效，初步分析术后复发的原因。方法：对我院1973年5月～1999年3月间19例采用大切口手术治疗的原发性滑膜软骨瘤病患者进行回顾性分析总结，并进行随访。结果：所有患者均得到术后病理证实。本组随访到8例患者，随访时间9月～8年5个月，平均随访4年5个月。3例膝关节、1例髋关节和1例踝关节患者术后复发。所随访到患者均未见有恶变。结论：①手术应彻底切除游离体，必要时可附加切口；②对于术前X线片显示较明显的钙化游离体，如钙化点分布较分散，术中有必要进行X线监测；③对于X线片未显示钙化影的，术前应进行CT或MRI检查。     

Evolution of arthroscopy: from a technique to a subspecialty

The arthroscope was first introduced to orthopaedics as a diagnostic instrument by Tagaki in 1918. A high degree of clinical accuracy, combined with low morbidity, has encouraged the use of arthroscopy to assist in diagnosis, to determine prognosis and often to provide treatment. Arthroscopy has dramatically changed the orthopaedic surgeons＇ approach to the diagnosis and treatment of a variety of joint ailments. Moreover, arthroscopists have specialised in sport medicine and this field was one of the most popular fellowship choices among graduating orthopaedic residents. Arthroscopy has already evolved to an important subspecialty of orthopaedics.     

全肩关节镜与关节镜辅助下切开治疗肩袖损伤的对比分析

目的:探讨全关节镜下肩袖修补术与关节镜下小切口肩袖修补术的临床疗效。方法:将62例肩袖撕裂性损伤的患者随机分为2组,A组患者采用全关节镜下肩袖修补术治疗,B组患者采用关节镜下小切口肩袖修补术进行治疗,比较2组的效果。结果:2组患者术后的ASES、VAS评分较之术前明显改善,差异有统计学意义(p<0.05),A组患者VAS评分改善较之B组,差异有统计学意义;但是2组患者在肩关节功能评分、患者满意度以及术后并发症等方面比较,差异无统计学意义(p>0.05)。结论:与关节镜辅助下小切口手术比较,虽然在术后肩关节功能评分、并发症以及患者满意度等方面无显著差异,但是全关节镜手术治疗肩袖损伤术后疼痛更轻,值得在临床中推广。     

关节腔注射、运动疗法联合中药熏洗治疗粘连期肩周炎的临床观察

目的 探讨关节腔注射、运动疗法联合中药熏洗治疗粘连期肩周炎的临床疗效。方法 将90例粘连期肩周炎患者随机分为对照组和治疗组,每组45例。对照组采取关节腔注射联合运动疗法治疗,治疗组在此基础上加用中药熏洗治疗,疗程为2周。治疗前后采用视觉模拟量表（visual analogue scale,VAS）评价肩关节疼痛程度,采用肩关节功能Melle评分量表及肩关节活动度评价肩关节活动度和功能,并观察两组临床疗效。结果 治疗后两组患者VAS评分、Melle评分均较治疗前降低（P＜0.05）;两组Melle评分差值比较,差异有统计学意义（P＜0.05）。治疗后两组患者的肩关节外展、内旋、外旋活动度均较治疗前增加（P＜0.05）;治疗组患者肩关节外展、内旋、外旋活动度升高值均显著高于对照组（P＜0.05）。两组临床疗效分布比较,差异有统计学意义（P＜0.05）。结论 两种治疗方案均能减轻肩关节疼痛,改善肩关节功能,关节腔注射、运动疗法联合中药熏洗对粘连期肩周炎的疗效优于关节腔注射联合运动疗法,能更好地改善肩关节功能和活动度。     

综合4步法治疗肩周炎208例报告

采用局部注射 ,针刀松解 ,手法剥离 ,中药调理 4步法有机结合治疗肩周炎 2 0 8例 ,结果治愈 187例 ,显效 13例 ,优良率 96.3 %。认为针对局部病变及肩部整体功能调理 ,是获得较好疗效的关键。     

下咽滑膜肉瘤1例报告

 滑膜肉瘤（synovial sarcoma，SS）是一类较为罕见的多发于四肢关节旁和周围腱鞘软组织的恶性肿瘤，位于头颈部原发的SS较为少见。现将2018年我科收治的1例下咽滑膜肉瘤患者进行报道。本例主要行手术治疗，方式为喉咽切除术+喉部分切除术+右侧颈部淋巴结清扫+气管切开术，根据术后病理学特征确诊为SS，遂予术后补充放疗。现今，多种治疗方式给SS的临床缓解、远期缓解带来了新的展望。