CT导向下经皮射频消融术治疗肾上腺恶性肿瘤

目的对29例肾上腺肿瘤患者行射频消融（RFA）治疗，研究其近期局部治疗效果、不良反应和副作用。方法肾上腺肿瘤患者共29例，病灶总数31个，其中直径≤2．0cm的病灶共5个，2．1-4．0cm者18个，4．1-6．0cm者5个，≥6．1cm者3个，经RFA治疗1个月后行螺旋CT双期增强扫描评价肿瘤治疗效果。结果上述病灶经消融治疗后达到完全坏死者分别为5个、18个、3个、2个。患者无严重并发症出现。结论RFA治疗安全可靠，副作用小，是治疗肾上腺恶性肿瘤的有效方法之一。     

腮腺手术中耳大神经后支保留的临床意义

目的 探讨腮腺手术中耳大神经后支保留的可行性、方法及临床价值。方法 我们对48例腮腺肿瘤患者，按常规隐蔽切口腮腺手术方法进行治疗，保留或不保留耳大神经后支。分别于术后10d及1、6、12个月进行随访，检测耳廓上部、耳垂、耳下区、耳前区和耳后区的触觉、痛觉，并观察其感觉变化情况。结果 48例中35例耳大神经后支保留，耳廓上部及耳后区感觉无减退。术后早期耳前、耳垂及耳下区感觉有不同程度的减退，以耳前区最明显，随着时间延长症状逐步好转，6个月时感觉接近正常。另13例耳大神经切断患者感觉减退症状更加明显，恢复时间延长。结论 腮腺手术中耳大神经后支保留是可行的，所采用的方法可靠，可减轻局部麻木感，提高患者术后早期生活质量，降低神经切断后产生局部永久性麻木的可能性。     

Insular carcinomas of the thyroid exhibit poor prognosis and long-term survival in comparison to follicular and papillary T4 carcinomas

Background Insular thyroid carcinoma was described as a tumor with aggressive behavior, and patients usually present themselves with an advanced tumor stage. Whether the insular component is an independent factor for poor prognosis remains unclear. Therefore, in the present study, we compared the survival of patients with advanced insular, follicular, and papillary thyroid cancer. Materials and methods The clinical behavior of tumors in three groups of patients with T4 thyroid carcinoma—8 patients with insular, 11 patients with follicular, and 21 patients with papillary thyroid carcinomas—was compared. Disease-free survival and disease-specific death were analyzed statistically. Cox regression analysis was used to evaluate the influence of histotype and other prognostic factors. Results At 3 years, survival was 37.5% (mean 26 months) among patients with insular thyroid carcinoma, 80% (mean 59 months) among those with follicular, and 89% (mean 126 months) among those with papillary thyroid carcinomas (p = 0.007). Disease-free survival in patients without initial distant metastasis was worst in patients with insular thyroid carcinoma (20%) compared to those with follicular (75%) and those with papillary thyroid carcinomas (71%). Conclusion Patients with advanced insular thyroid carcinoma have a poorer outcome in comparison to patients with similar advanced stage who have follicular or papillary thyroid carcinoma.     

CT、MRI对肾上腺病变的诊断分析

目的:分析探讨CT、MRI诊断对肾上腺病变的作用与价值。方法:MarconiMX8000 4层螺旋CT机,增强造影剂使用非离子型制剂,常规扫描及增强。应用西门子MAGNETOM1.5T磁共振机,增强造影剂使用Gd-DTPA制剂,常规T1WI、T2WI、脂肪抑制、化学位移同反相位及增强。对25例经手术及病理资料诊断证实的肾上腺病变进行CT、MRI诊断回顾性分析。结果:可清楚显示肾上腺病变的侧别、数目、大小、范围及可能的性质。结论:CT是肾上腺病变最佳影像检查方法,MRI具有重要辅助及补充诊断价值。     

腮腺多形性腺瘤与沃辛瘤MRI表现对照分析

目的:探讨磁共振成像检查对腮腺多形性腺瘤与沃辛瘤的鉴别诊断价值。方法:回顾分析经病理证实的8例腮腺多形性腺瘤及10例腮腺沃辛瘤的磁共振成像检查表现,并作统计学处理。结果:腮腺多形性腺瘤为单侧腮腺单发病灶(8/8),沃辛瘤可单侧单发(5/10),亦可双侧或多发(5/10)(P<0.05);沃辛瘤多位于腮腺浅叶(13/17),腮腺多形性腺瘤可位于浅叶(6/8),亦可位于深叶或占据深浅叶(2/8)(P<0.05);多形性腺瘤在T2WI中以高信号多见(5/8),沃辛瘤以等信号或低信号为主(17/17)(P<0.05);性别分布上腮腺多形性腺瘤女性多见(6/8),沃辛瘤男性多见(7/10)(P<0.05);年龄分布上沃辛瘤为50岁以上者多见(6/10),多形性腺瘤中50岁以上与50岁以下者分布相近,各为4例(P<0.01)。结论:磁共振成像检查的特征表现和临床资料相结合对腮腺多形性腺瘤与沃辛瘤可正确诊断。     

肾上腺区神经节细胞瘤(附18例报告)

目的较全面的了解神经节细胞瘤的临床特点及治疗方法。方法回顾性分析18例病理确诊的神经节细胞瘤患者临床表现、实验室检查、影像学检查和治疗效果。结果15例是无临床症状的影像学偶然发现病例,内分泌检查均在正常范围;另外3例以阵发性高血压为主要临床表现,其中1例尿儿茶酚胺升高,肾上腺髄质显像(MIBG)阳性。18例B型超声检查均为低回声;13例CT平扫见散在点状高密度影,12例CT增强扫描肿瘤周边强化明显。手术前诊断为嗜铬细胞瘤12例,神经节细胞瘤4例,肾上腺无功能腺瘤2例。18例行肿瘤切除,随访6个月~7年,高血压症状消失,2例肿瘤复发。结论肾上腺区神经节细胞瘤与肾上腺髄质肿瘤难以鉴别,综合各项影像学检查对诊断有较高的参考价值。手术治疗是唯一的有效方法。     

Chronic GVHD in minor salivary glands and oral mucosa: histopathological and immunohistochemical evaluation of 25 patients

BACKGROUND: Graft-vs.-host disease (GVHD) is the major cause of morbidity and mortality in patients undergoing allogeneic Bone Marrow Transplantation (BMT). The aim of our study was to identify the most relevant histological features for diagnosis of chronic Graft-vs.-Host Disease (cGVHD) in oral mucosa and minor salivary glands of 25 patients, as well as to evaluate the immunophenotype of the inflammatory cells. METHODS: Sixteen patients that were submitted to allogeneic BMT but did not present cGVHD were selected as a control group. The sections were studied on H & E and CD68, CD45, CD4, CD8, CD20 staining. RESULTS: The most frequent histologic findings in oral mucosa at the day of diagnosis of cGVHD were: hydropic degeneration of the basal layer of the epithelium, apoptotic bodies, lymphocytic infiltration, and focal or total cleavage between the epithelial and connective tissue. In the labial salivary glands (LSG), lymphocytic infiltration, acinar loss and fibrosis were the main alterations. Cytotoxic CD8-T cells and macrophages were predominant both in the epithelium and connective tissue, as well as in minor salivary glands. CONCLUSIONS: Histological features were useful in the diagnosis of oral cGVHD. It is suggested that CD8-T cells and macrophages play important role in the pathogenesis of the disease.     

Acetylcholine Synthesis in a Primary Culture of Porcine Intermediate Lobe Cells

Previous pharmacological studies with the pituitary gland have suggested that acetylcholine (ACh) might be involved in the regulation of intermediate lobe (IL) function. Whether ACh is endogenous to the IL cells or provided from an extrinsic source is unclear. The present experiments tested the possibility that the endocrine cells of the IL may be a source of ACh by measuring certain cholinergic markers in a primary culture of dissociated porcine cells. The endogenous ACh content was readily measurable in both the freshly dissociated IL cells and in 2- or 4-day primary cultures. Choline acetyltransferase activity was also measurable in the freshly dissociated and cultured IL cells and was reduced by 53% in the presence of a specific inhibitor, napthylvinylpyridine (50 μM). IL cells incubated in the presence of [¹⁴C]choline (1 μM) were able to synthesize [¹⁴C]ACh and the accumulation of the new ACh was inhibited by hemicholinium-3 (30 μM), a competitive inhibitor of high affinity choline uptake at cholinergic nerve terminals. In conclusion, these results demonstrate that the endocrine cells of the IL are capable of synthesizing and storing ACh.     

Early organization of the pituitary gland in Sparus aurata L. (Teleostei) An ultrastructural study

The cell organization of the pituitary gland and the relationship between neurohypophysis and adenohypophysis in the early developmental stages of the gilthead sea bream, Sparus aurata, were studied by electron microscopy. In newly hatched larvae, the pituitary gland was embedded in the ventral floor of the diencephalon and separated from the hypothalamus by a continuous basal lamina. Elongated mesenchymal cells next to the ventral surface were observed. At this stage, there was no neurohypophysis and the adenohypophysis consisted of undifferentiated endocrine cells with small scarce secretory granules and a few stellate cells, with no distinctive zonation. An incipient neurohypophysis was present in 1-day-old larvae. The first evagination of the neurohypophysis into the adenohypophysis were observed in 2-day-old larvae and developed progressively with age, being deeper in the caudal zone. Two regions in the adenohypophysis, one anterior — the presumptive pars distalis — and one posterior — the presumptive pars intermedia — were found in 2-day-old larvae. Three regions (rostral and proximal pars distalis and pars intermedia) were clearly distinguishable in 4-day-old larvae. The ultrastructural features of the pituitary endocrine cells varied during gland differentiation, with the secretory granules gradually increasing in number and size, accompanying organelle development. Nevertheless, even in the oldest larvae studied (65 days), undifferentiated cells similar to those in the earliest stages were observed. The first blood vessels appeared in the neurohypophysis around 16 days after hatching. During early development, the pituitary gland progressively emerged from the ventral floor of the brain. By 16 days, the principal pattern of the pituitary gland architecture appeared to be established.