腮腺良性和恶性多形性腺瘤的超声研究

目的研究腮腺良性和恶性多形性腺瘤的超声特点,为临床医师诊治提供有效依据。方法选取腮腺良性多形性腺瘤患者79例和恶性多形性腺瘤患者15例,对其肿块的大小、硬度、内部回声、彩色多普勒血流显像(CDFI)特点结合病理学诊断进行对照研究。结果恶性多形性腺瘤的声像图特点与良性多形性腺瘤相似,但其肿瘤相对较大,质地更硬,内部回声分布更紊乱。不同性质的肿瘤的大小和质地有显著性差异,(P<0.01)。结论多形性腺瘤的超声诊断主要依据二维图像之特点。当多形性腺瘤大于3.0 cm,硬度较硬,内部回声分布不均多提示恶性。     

Endovascular stent-graft treatment of type A dissection: case report and review of literature.

We report a successful endovascular stent-graft treatment of a patient with type A dissection with primary entry tear at the ascending aorta. Simultaneous coronary stenting was performed. A literature review was performed and the possible use of endovascular treatment for ascending aortic dissections is discussed.     

PM01SPINAL CORD STIMULATION FOR CHRONIC REFRACTORY ANGINA

Spinal cord stimulation (SCS) involves the use of an epidurally placed, multiple electrode lead. Electrical stimulation between electrodes produces stimulation of the posterior spinal cord and can provide excellent pain relief and increased blood flow in a number of chronic limb pain conditions. Its efficacy has more recently been demonstrated in angina. Chronic stable angina pectoris is a major cause of disability and suffering. The aims of treatment are to prevent MI and death (increase the quantity of life) and reduce the symptoms (improve the quality of life). In the non‐acute condition, practitioners often struggle to manage angina because of a lack of understanding of modern concepts of pain. There is a widely held misconception that only revascularisation improves prognosis in chronic refractory angina‐ the term used to describe patients with stable angina that is treatment refractory. Over the last decade two pain services in New Zealand have been approached by cardiologists to provide spinal cord stimulation for such patients. This has been an intriguing experience! We have demonstrated that the placement of such leads in the lower cervical cord region provides excellent relief of angina. The technology is expensive (akin to the overall cost of CAVG surgery). We have demonstrated cost recoupment, by decreased hospitalisation, at approximately16 months post procedure. Sadly, this therapy has not been embraced. Possible reasons for this will be discussed. The concept of electrically modifying the neuronal signals versus re‐plumbing the blockage appears to be an anathema to cardiologists.     

Clinical outcome after D1 vs D2-3 gastrectomy for treatment of gastric cancer.

BACKGROUND: Clinical benefit from extended lymphadenectomy for gastric cancer remains controversial as a considerable variation exists between results of different studies. METHODS: 562 patients were treated at HUCH between 1987-2003, whereof 223 underwent gastrectomy with curative intent. Of these, 114 patients underwent subtotal/total gastrectomy with D1 (standard) lymphadenectomy and 109 patients had D2-3 (extended) lymph node dissection. The clinical outcome of these patients was analysed retrospectively. RESULTS: The incidence of surgical complications was 33.0% in D2-3 and 16.8% in D1 lymphadenectomy groups (p = 0.008). Abscess was the most common complication (11.0%) among D2-3 operated patients and haemorrhage (4.4%) in D1 group. Hospital mortality was 3.7% in D2-3 and 1.8% in D1 group (p = 0.438). The only statistically significant factor influencing the rate of complications was D2-3 lymphadenectomy (OR 2.620, 95% C.I. 1.375 to 4.991). D2-3 was associated with a longer postoperative hospital stay and operation time, greater blood loss and increased need for blood transfusions compared to D1. The 5-year survival was not statistically different between lymphadenectomy groups. CONCLUSION: It is justified to perform a D2-3 gastrectomy in Europe with a acceptable postoperative mortality but with a significant morbidity. Further studies are needed to assess the value of extended lymphadenectomy in gastric cancer.     

An intra-articular vascular malformation with a ganglion in a knee

We report a case of an intra-articular vascular malformation occurring simultaneously with a ganglion in a knee joint. We believe this to be the first reported case of an intra-articular vascular malformation occurring simultaneously with a ganglion. The malformation was cauterized resulting in resolution of knee pain. We suggest that vascular malformations be considered in the differential diagnosis of knee pain.