进展期胃癌淋巴结转移的特点及临床意义

目的 探讨胃癌淋巴结(LN)转移的规律,指导胃癌LN廓清手术治疗。方法 回顾分析我院近5年来D_2或>D_2手术并有完整记录的298例进展期胃癌患者的临床资料,统计胃癌各组LN的转移情况。结果 术中LN肉眼检查与实际病理检查有一定的误差。D_2手术时,只要把No.12LN包括在内,部分LN归属哪一组,并不影响肿瘤的治疗和预后。在各组LN中,No.3、No.7、No.8、No.9 LN转移率最高,而No.13、No.17、No.18 LN对于不同部位的胃癌转移机会均很少,不同部位的胃癌No.3、No.4、No.7、No.8、No.9、No.11、No.16 LN转移机会大致相同。胃癌的LN跳跃式转移见于No.16 LN,而第3站的LN较为少见。探查时若无No.12 LN转移,No.13 LN病理检查均未见转移,可不必清扫。组织学类型分化低的胃癌其第3、4站LN转移相对少见,这可能与分化低的肿瘤易引起远处转移,而使患者失去根治手术的机会有关。结论 掌握胃癌LN的转移规律,对胃癌LN的廓清手术具有重要意义。     

Fibrolamellar Hepatoma

Primary hepatocellular carcinoma (HCC) has a high incidence rate worldwide with an extremely grave prognosis, but, fortunately, accounts for only 2% of all cancers in the United States. Yet, a unique subset of HCC fibrolamellar hepatocellular carcinoma (FLHC) is reported only from the United States. Five cases of FLHC from the University of Minnesota's 17 years of experience are reported and compared with the literature reports for FLHC, as well as contrasted to reports of HCC. The review of the literature is addressed for data evaluating FLHC as a distinct entity from HCC.     

口服避孕药：不会增加死亡风险

本研究旨在确定服用口服避孕药的女．胜其死亡风险是否高于未服用者。本次前瞻性试验研究，由英国全科医生资料库和（或）国家健康服务中心登记处提供始于1968年的死亡资料，对46112位女性持续观察了39年，其中未使用口服避孕药的女性为378006人年，曾服用者为819175人年，主要观察终点未口服和口服避孕药者之间全因和特异性死亡的相对风险。     

Serious and fatal air gun injuries: more than meets the eye

OBJECTIVE: To describe the epidemiology of air gun injuries to children that required hospitalization. DESIGN: A consecutive series of children with air gun injuries. SETTING: Urban pediatric teaching hospitals in Cincinnati, OH; Kansas City, MO; and Seattle, WA. METHODS: A retrospective chart review. RESULTS: A total of 101 children were studied: 81% were male; 80% were white, 18% were black, and 2% were other races. The median age was 10.9 years (range, 0.5 to 18.8). Victims were most commonly shot by a friend (30%) or sibling (21%). A total of 34% occurred at the victim's home, and 36% occurred at the home of a friend or relative. Although 71% of shootings were unintentional, 5% were assaults, and 1% were suicides. The median hospital stay was 3 days (range, 1 to 17 days). Fifteen children (15%) required treatment in intensive care. A total of 56% required at least one surgical procedure. Forty-nine had injuries to the head, including 38 with injuries to the eye, 10 with intracranial injuries, and 1 with a skull injury. Fourteen children were shot in the neck; 15 were shot in the chest, with 2 patients sustaining lacerations of the pericardium and 1 having a right ventricular foreign body. Another child had a laceration of the innominate artery. Nineteen had abdominal injuries, including laceration of the stomach (N = 3), small bowel (N = 4), colon (N = 2), and liver (N = 3). Three of 10 children with intracranial injuries died. Two had long-term neurologic deficits. Of children with eye injuries, 25 (66%) had permanent visual loss and 15 (39%) of these were blind. CONCLUSION: Air guns are associated with serious and fatal injuries. Families should be counseled that air guns may cause serious injuries and even death. Furthermore, pediatric care givers should advocate for increased regulation of air guns and expansion of safety standards.     

Proliferation, differentiation, and cytogenetics of chronic leukemic B lymphocytes cultured with mitomycin-treated normal cells

Lymphocytes from 6 patients with chronic lymphocytic leukemia of the B- cell variety (B-CLL) were cultured with equal numbers of mitomycin- treated mononuclear cells from normal blood. When stimulated with pokeweed mitogen (PWM), phytohemagglutinin (PHA), or the tumor- promoting agent, phorbol tetradecanoyl-acetate (TPA), the CLL cells proliferated actively by day 3 or 4 of culture, and in four cases, differentiated to significant numbers of immunoglobulin-containing cells. Chromosome studies on the proliferating lymphocytes demonstrated a cytogenetically abnormal clone in three patients, including two with a 14q+ marker chromosome and two with a translocation involving the short arm of chromosome 9. One patient had a translocation from 22q to 14q, producing a Philadelphia chromosome as well as the 14q+ marker. The results indicate that the neoplastic lymphocytes of B-CLL may proliferate and differentiate when appropriately stimulated in vitro, and that chromosomally abnormal clones are not uncommon. With several techniques now available for successful short-term culture of B-CLL lymphocytes, there is opportunity for better understanding of the cellular alterations in this disease.     

Transarterial chemoembolization for liver metastases from solid pseudopapillary epithelial neoplasm of pancreas: A case report

Solid pseudo-papillary epithelial neoplasm(SPEN) is a rare epithelial tumor of pancreas with a low malignant potential occurs most commonly in young females. We report a case of 40 years old woman presented withextensive liver metastasis from SPEN of pancreatic body for which she was operated four years ago. Due to the extensive nature of metastatic disease she was offered Transarterial chemoembolisation(TACE) using gemcitabine as chemotherapeutic agent. Short term follow up after a month of TACE with multiphase computed tomography showed > 90% resolution in the viable tumor with significant clinical improvement. TACE ensures targeted delivery of chemotherapeutic drugs in higher doses with least systemic toxicity and is more effective and safe than systemic chemotherapy. TACE with gemcitabine was found to be very effective in our patient with numerous liver metastasis.     

One-stage revision in two cases of Salmonella prosthetic hip infection

We describe two cases of prosthetic joint infection (PJI) of the hip due to Salmonella. The first patient presented with an early infection 5 d after being discharged following a total hip replacement and the second patient presented at the emergency ward with a late infection, thirteen years following a total hip replacement. Both cases occurred within one month of each other at our institution and both were successfully treated with a one-stage revision. PJI caused by Salmonella species is very rare: so far only 20 Salmonella PJIs of the hip have been described. Therefore, full consensus on the best treatment approach has not yet been reached. An aggressive two-stage approach is advised because of the virulence of Salmonella, although a limited number of successful one-stage approaches have been described as well. According to the latest guidelines, one-stage revision has comparable success rates and less morbidity compared to two-stage treatment, when selecting the right patients. In our opinion, PJI caused by Salmonella should be treated just as PJI caused by other bacteria, with consideration of the selection criteria as mentioned in several treatment guidelines. As illustrated by these two cases, one-stage revision can be successful in both early and late Salmonella PJI of the hip.