内乳淋巴结在乳腺癌治疗中的重要性

目的探讨乳腺癌术后内乳淋巴结复发的原因,强调内乳淋巴结在乳腺癌治疗中的重要性。方法回顾性分析40例以内乳淋巴结转移为首先复发的女性乳腺癌患者的临床资料、初发病时的临床特征、手术方式、术后病理分期以及治疗经过。结果40例患者内乳淋巴结复发与患者年龄、经期状况、手术方式无关(P>0.05)。而与原发肿瘤直径、部位、腋窝淋巴结阳性数、临床病理分期相关(P<0.05)。结论位于乳腺内侧区、中央区的大块肿瘤(>3cm),腋窝淋巴结阳性数多(>3),且临床病理分期晚(IIb IIIab)的乳腺癌患者,内乳淋巴结转移机率较高,须加强术后综合治疗。     

雌二醇对不同性质的乳腺原代细胞增殖影响的体外研究

目的了解在体外条件下不同浓度的雌二醇对不同性质的乳腺组织原代细胞增殖的影响。方法用胶原酶消化法获取乳腺癌患者的各类乳腺组织原代细胞，并用MTT法检测乳腺癌组织、癌旁组织和正常乳腺组织原代细胞在体外培养下，给予不同浓度雌二醇时细胞的生长增殖情况。结果雌激素在体外对雌激素受体（ER）表达阳性的乳腺癌组织及癌旁组织原代细胞有明显的刺激生长作用；对正常乳腺组织细胞的促生长作用相对较弱，而且与肿瘤组织的ER表达情况无关。结论当体内的雌二醇水平≥10μmol／L时，乳腺癌的发病风险和复发风险会显著增加。     

超声引导下VacoraTM旋切系统的实验研究

目的探讨VacoraTM真空辅助活检系统的准确性和安全性,为临床应用奠定基础。方法选用里脊肉和鱼丸作为实验材料,根据鱼丸大小将实验分为5组:0.5、0.8、1.0、1.5及2.0cm组,每组鱼丸3~5个。采用VacoraTM活检系统,先行灰阶超声扫查肌肉后将鱼丸置入肌肉中,超声扫查置入的鱼丸,同轴套管针在超声引导下插入鱼丸底部,在套管针引导和超声监视下行旋切真空抽吸术;旋切后取出采样腔内的组织标本,用超声检查肌肉内的残腔,确定无鱼丸残留声像图。结果每次旋切组织条比较完整,其大小为20.0mm×0.6mm,旋切次数随鱼丸大小的增加而增加;0.5、0.8、1.0、1.5及2.0cm组里脊肉内鱼丸全部切除的平均旋切次数分别为12、15、19、26和31。所用的平均时间分别为15、18、23、27和34min。结论VacoraTM真空辅助活检系统定位准确、取样完整、操作简便。可为良恶性病变的诊断提供足够量的病理检查标本,为良性病变的完全切除提供具有潜在价值的手段。     

Body Mass Index and Glomerular Hyperfiltration in Renal Transplant Recipients: Cross-Sectional Analysis and Long-Term Impact

Obesity is a risk factor for renal graft loss. Higher body mass index (BMI) in native kidneys is associated with glomerular hyperfiltration. Whether higher BMI in renal transplants is associated with hyperfiltration is unknown. We investigated the impact of BMI on renal hemodynamics 1 year post-transplant. We analyzed glomerular filtration rate (GFR, (125)I-iothalamate) and effective renal plasma flow (ERPF, (131)I-hippurate) in 838 kidney transplants. Data were analyzed for all patients and for the subpopulation without diabetes. Long-term impact of BMI and renal hemodynamics were explored by Cox-regression. With higher BMI GFR and filtration fraction (FF) increased significantly. Multivariate analysis supported impact of BMI on GFR (adjusted r(2) of the model 0.275) and FF (adjusted r(2) of the model 0.158). This association was not explained by diabetes mellitus. On Cox-regression analysis, lower GFR and higher FF were independent determinants of overall graft loss and graft loss by patient mortality. Lower GFR and higher BMI were determinants of death-censored graft loss, with borderline contribution of higher FF. In renal transplants higher BMI is independently associated with higher GFR and FF one year posttransplant, suggesting glomerular hyperfiltration with altered afferent-efferent balance. Mechanisms underlying the long-term prognostic impact of hyperfiltration deserve further exploration.     

单蒂横行腹直肌肌皮瓣乳房再造中Ⅳ区皮瓣的取舍

目的探讨单蒂横行腹直肌肌皮瓣乳房再造术中Ⅳ区皮瓣的取舍。方法通过16例实施单蒂横行腹直肌肌皮瓣乳房再造术，术中观察皮瓣的皮色、断面出血颜色，并利用近红外血氧监测仪测定皮瓣各区的组织血氧饱和度，决定Ⅳ区皮瓣的取舍。术后观察指标包括术后并发症及美学效果。结果16例中5例Ⅳ皮瓣的肤色正常、断面出血呈鲜红色而非暗红色、组织血氧饱和度不低于Ⅲ区组织血氧饱和度的95％。在接受了保留Ⅳ区皮瓣的单蒂横行腹直肌肌皮瓣乳房再造术后，再造乳房全部成活，无严重术后并发症，患者对再造乳房均很满意。结论近红外血氧无创检测有助于决定Ⅳ区皮瓣的取舍。有选择地实施保留Ⅳ区皮瓣的单蒂横行腹直肌肌皮瓣乳房再造术，可用于大面积胸壁缺损或乳腺尾叶的修复重建。     

包膜囊上再置乳房假体隆乳术

目的探究隆乳术后包膜囊挛缩的手术治疗方法。方法采用原切口(腋窝顶或乳房皱襞下)，对隆乳后包膜挛缩者采用包膜囊保留并在其浅层再置人假体的方法进行治疗。结果治疗12例14侧乳房包膜囊挛缩症均取得良好效果。结论保留挛缩的包膜囊并在其浅层置人假体的乳房假体包膜囊挛缩治疗术具有创伤小、出血少、操作简便、安全性高、复发率低、并可通过腋窝顶小切口完成等优点，是治疗乳房假体包膜囊挛缩的较好方法。     

The diagnostic value of image guided percutaneous fine needle aspiration biopsy in equivocal mediastinal masses

Background and aims The aim of this study was to assess the diagnostic value of image guided percutaneous fine needle aspiration (FNA) biopsy in equivocal mediastinal masses.Patients Sixty-six patients with an equivocal mediastinal mass who underwent FNA biopsy between 1993 and 2003 were eligible for final analysis. The cytological and definitive diagnosis of masses were grouped as primary 22 (33%)−30 (46%) and secondary (metastatic) neoplasms 18 (27%)−18 (27%) and nonneoplastic lesions 20 (30%)−18 (%27) respectively.Results The diagnostic accuracy (%95 C.I.) of FNA biopsy for primary mediastinal neoplasms, secondary neoplasms and nonneoplastic lesions were found to be 93.3 (83.8–98.2)%, 100 (95.1–100)%, 93.3 (83.8–98.2)%, respectively.Conclusion Image guided percutaneous FNA biopsy is a safe and highly accurate diagnostic method for equivocal mediastinal masses.     

Urological emergency in neonates with congenital hydronephrosis

OBJECTIVE: It is well described that unilateral pelviureteric junction obstruction (PUJO) is a benign condition, because the dilatation resolves spontaneously and the function does not decrease in most of the kidneys. However, there is exceptional PUJO that requires emergent treatment in neonatal periods. The aim of this article is to report the urological emergency and management in neonates with PUJO. MATERIALS AND METHODS: Nine children (seven boys and two girls) with PUJO who underwent neonatal emergent treatment during the last 13 years were reviewed. Renal function was evaluated according to decay curve of serum creatinine (SCr) levels corresponding to gestational age (GA) at delivery. Physical examination, ultrasonographic monitoring, and chest and abdominal plain radiographs were repeated in each neonate. RESULTS: Eight patients were detected prenatally. In five patients, multicystic dysplastic kidney (MCDK) was demonstrated on the contralateral side. Three patients underwent percutaneous puncture of fetal hydronephrosis. Decrease of amniotic fluid was evident in three fetuses. Indications for emergent treatment included mass effect from hydronephrosis in three patients, renal dysfunction in five, and severe urinary tract infection in one. During neonatal periods, a percutaneous nephrostomy tube was placed in seven, and open nephrostomy in one with anorectal malformation. Repeated punctures of the dilated renal pelvis were done in one patient. Renal function after pyeloplasty was stable in eight patients, while it was moderately decreased in one who was associated with oligohydramnios in utero. CONCLUSION: Indications for emergent treatment in neonates with PUJO included mass effect from giant hydronephrosis, renal dysfunction and severe urinary tract infection. At birth, respiratory and circulatory conditions must first be stabilized. In neonates with hydronephrosis of the solitary kidney or severe bilateral PUJO, serial SCr should be monitored to evaluate renal function. Decrease of amniotic fluid suggested renal functional compromise that would not recover after urological management.     

Preference for donor site scar orientation in pedicled latissimus dorsi breast reconstruction

A survey was carried out to ascertain the preference for donor site scar orientation in patients undergoing pedicled latissimus dorsi breast reconstruction and their views on breast reconstruction in general. One hundred twelve women (59 Chinese, 53 Western) completed the questionnaire. Participants were asked to state their preferred scar orientation (i.e., oblique, horizontal, or vertical) based on photographs showing the position of the scars. Demographic information and views on issues surrounding breast reconstruction in general were also collected. Data was analyzed non-parametrically with chi-square test and t test. The mean age of participants was 39.5 years (20–73 years). Seventy-seven percent of the participants would opt for an immediate breast reconstruction if offered (p < 0.001). Eighty-six percent would have objection to the use of silicone implant as a whole or part of a reconstruction (p < 0.001). Vertical and horizontal scars were the preferred orientation, with no women choosing the oblique orientation as their first choice (p < 0.001). The non-Chinese of 40 years or older, as well as Chinese women from all age groups, preferred the horizontal scar (p < 0.05). We demonstrated that both culture and age impact on the preferred scar orientation in breast reconstruction. Women in the age group we commonly reconstruct favored the horizontal scar. However, the younger women of non-Chinese origin tended to favor the vertical scar.     

Primary malignant melanoma: a rare cause of mediastinal mass

A case of primary malignant melanoma in the mediastinum presenting as recurrent laryngeal nerve palsy is reported. Tissue biopsy at mediastinotomy yielded a diagnosis of malignant melanoma. The mass was fixed to the left aspect of the trachea and to the upper border of the left main bronchus and could not be removed surgically. Further extensive clinical and radiological investigations revealed no evidence of tumor elsewhere in the body.