Adrenal tumors discovered incidentally on ultrasonography: three case reports

A series of three adrenal tumors is reported. They were discovered incidentally on ultrasonography for screening. One case was a benign pheochromocytoma and the others were non-functioning adrenocortical adenomas. They were hypoechoic on ultrasonography and were 4.5 x 3.5 x 4.0, 3.0 x 2.5 x 2.5 and 3.5 x 2.5 x 2.0 cm. Non-functioning adrenal tumors of a diameter smaller than 3.0 cm generally tended not to require surgery. Ultrasonography is useful for screening and evaluating patients with an adrenal mass without surgery as well as is computed tomographic scan.     

Evans蓝灌注血管造影对改良型高氧诱导小鼠视网膜新生血管形态观察

目的 验证Evans蓝灌注血管造影对小鼠视网膜新生血管形态观察的可行性.方法 C57BL/6J小鼠于生后7 d置于含体积分数（75±2）%氧气的密闭氧箱内,每日加食换水替换母鼠,5 d后返回正常大气环境,制作高氧诱导的小鼠视网膜新生血管动物模型.于生后15 d、17d、19 d、21 d、24 d、30 d麻醉小鼠后行质量分数2%Evans蓝上腔静脉灌注,5 min后处死,摘取眼球,固定后视网膜铺片,荧光显微镜下观察、照相.结果 Evans蓝灌注血管造影可以清楚地显示小鼠视网膜深浅2层血管网及中间的连接血管,并能动态反映高氧诱导的小鼠视网膜形成无灌注区、血管扩张迂曲及渗漏、新生血管及血管瘤的形成.后期血管增殖反应慢慢消退这一过程也能呈现.显影清晰、完全,方法简便、可重复性高.结论 Evans蓝灌注血管造影可准确、动态反映小鼠视网膜新生血管病变形态特点,且价格低廉、简单易行,为视网膜新生血管性眼病的预防与治疗提供广阔的研究前景.     

Nerve repairs for traumatic brachial plexus palsy with root avulsion

Thirty-six patients with traumatic brachial plexus lesions and root avulsions were treated surgically between 1972 and 1986 and were followed for more than 24 months (average, 42.6 months). Neurotization of the musculocutaneous nerve with intercostal nerves or the spinal accessory nerve resulted in satisfactory elbow flexion in 21 of the 33 cases (64%). Combined nerve repairs (i.e., intercostal and spinal accessory neurotization of the terminal branch of the brachial plexus in combination with nerve grafts from the upper spinal nerves of the brachial plexus) created a useful function in at least one functional level of the upper limb for 11 of the 15 cases so treated. Nerve repairs resulted in stability of the shoulder and elbow function controllable with a sensible hand for patients with root avulsion injury of the brachial plexus.     

溶栓治疗瓣膜置换术后心内血栓的疗效观察

人工瓣膜置换术后心内血栓包括人工瓣膜血栓和左心房血栓,是心脏瓣膜置换术后最严重的并发症之一,其中人工瓣膜血栓每年的发生率为0.2%~6%[1]。目前对瓣膜置换术后心内血栓的治疗主要为溶栓疗法及手术治疗。手术风险较大、费用高;溶栓治疗费用低、风险小,但在诸多方面存在着争议。现回顾性分析2010年9月-2014年6月在笔者医院住院的29例人工瓣膜置换术后心内血栓患者予以尿激酶溶栓治疗的临床资料,报告如下。     

Utility of a simplified ultrasonography scoring system among patients with rheumatoid arthritis: A multicenter cohort study

We aimed to evaluate the utility of a simplified ultrasonography (US) scoring system, which is desired in daily clinical practice, among patients with rheumatoid arthritis (RA) receiving biological/targeted synthetic disease-modifying antirheumatic drugs (DMARDs).A total of 289 Japanese patients with RA who were started on tumor necrosis factor inhibitors, abatacept, tocilizumab, or Janus kinase inhibitors between June 2013 and April 2019 at one of the 15 participating rheumatology centers were reviewed. We performed US assessment of articular synovia over 22 joints among bilateral wrist and finger joints, and the 22-joint (22j)-GS and 22-joint (22j)-PD scores were evaluated as an indicator of US activity using the sum of the GS and PD scores, respectively.The top 6 most affected joints included the bilateral wrist and second/third metacarpophalangeal joints. Therefore, 6-joint (6j)-GS and -PD scores were defined as the sum of the GS and PD scores from the 6 synovial sites over the aforementioned 6 joints, respectively. Although the 22j- or 6j-US scores were significantly correlated with DAS28-ESR or -CRP scores, the correlations were weak. Conversely, 6j-US scores were significantly and strongly correlated with 22j-US scores not only at baseline but also after therapy initiation.Using a multicenter cohort data, our results indicated that a simplified US scoring system could be adequately tolerated during any disease course among patients with RA receiving biological/targeted synthetic DMARDs.     

Diagnostic accuracy of tumor staging and treatment outcomes in patients with superficial esophageal cancer

Background We examined the current status and diagnostic accuracy of currently available techniques for tumor staging and assessed treatment outcomes in patients with superficial esophageal cancer who received esophaguspreserving therapy, such as endoscopic mucosal resection (EMR) alone or combined with chemoradiotherapy (CRT). Methods In 274 patients with superficial esophageal cancer, we examined the depth of tumor invasion and the degree of lymph node metastasis by means of endoscopy, magnifying endoscopy, endoscopic ultrasonography (EUS), computed tomography (CT), and cervical and abdominal ultrasonography (US). We compared treatment outcomes among treatment groups according to the depth of tumor invasion. Results The rates of correctly diagnosing the depth of tumor invasion were 89.6% on conventional endoscopy, 90.1% on magnifying endoscopy, and 85% on scanning with a high-frequency miniature ultrasonic probe (miniature US probe). Diagnostic accuracy for the m3 or sm1 cancers was poor. Magnifying endoscopy allowed invasion to be more precisely estimated, thereby improving diagnostic accuracy. However, lesions that maintained their surface structure despite deep invasion were misdiagnosed on magnifying endoscopy. A miniature US probe was useful for the assessment of such lesions. The diagnostic accuracy of EUS for lymph node metastasis was 83%, with a sensitivity of 76%. The sensitivity of CT was 29%, and that of cervical and abdominal US was 17%. Patients with m1 or m2 cancer had good outcomes after esophagus-preserving therapy. Although there were no significant differences in survival rates, many patients with sm2 or sm3 cancer who received CRT died of their disease. Nodal recurrence was diagnosed by EUS. In patients who received CRT, the time to the detection of recurrence was slightly prolonged. Conclusions Long-term follow-up at regular intervals is essential in patients with m3 or sm esophageal cancers who receive esophagus-preserving treatment. At present, EUS is the most reliable technique for the diagnosis of lymph node metastasis and is therefore essential for pretreatment evaluation as well as for follow-up. Earlier detection of recurrence at a level that would potentially salvage treatment remains a topic for future research. Review articles on this topic also appeared in the previous issue (Volume 4 Number 3). An editorial related to this article is available at .