动态增强MR灌注成像在脑胶质瘤诊断中的价值

目的　探讨动态增强T2 WMR灌注成像在脑胶质瘤术前分级预测及鉴别诊断中的价值。资料与方法　有病理或追踪结果的 4 8例脑病变患者 ,其中胶质瘤 2 5例 (高、低级别胶质瘤分别为 16例和 9例 ) ,非胶质瘤病变 2 3例。全部病例均行常规T1WI、T2 WI和EPI SE序列动态增强MR灌注成像。计算每个病灶的最大相对脑血容量 (rCBV)比值 (病灶最大rCBV/对侧正常脑白质rCBV)。分析胶质瘤的最大rCBV比值与其组织学级别的关系 ,并比较胶质瘤与非胶质瘤的灌注异常及常规MRI强化表现。结果　高级别胶质瘤 ( 16例 )的最大rCBV比值为4 .6 0± 1.98( 2 .5 5～ 9.2 2 ) ,低级别胶质瘤 ( 9例 )的最大rCBV比值为 1.86± 1.5 2 ( 0 .85～ 5 .72 ) ,经t检验 ,两组之间有显著统计学差异 (P <0 .0 1)。脑膜瘤、转移瘤、血管母细胞瘤、淋巴瘤均显示有局部高灌注 ,最大rCBV比值为5 .35± 2 .39( 3.15～ 12 .39) ,而有强化表现的脑梗死、脑炎性灶及放射性脑损伤表现为低、等灌注 ,最大rCBV比值为1.2 7± 0 .36 ( 0 .85～ 1.72 )。结论　MR灌注成像在胶质瘤的术前影像学分级预测上有重要价值 ,在脑胶质瘤的某些鉴别诊断上亦具有一定的参考价值     

肺隔离症的影像诊断和介入治疗

目的探讨肺隔离症的影像学表现及介入治疗的应用价值. 资料与方法对5例肺隔离症患者的X线平片、CT、MRI表现进行分析,并对隔离的肺组织的供血动脉进行栓塞. 结果 X线平片主要表现为囊状或团状高密度影及支气管扩张样改变,CT、MRI可发现部分异常供血动脉,血管造影均能发现供血动脉,经异常供血动脉采用不锈钢圈栓塞后临床症状逐渐减轻、消失,随访6个月～1年,症状未再复发. 结论在影像诊断方面,X线平片难以确诊,CT、MRI可部分确诊,而DSA检查是肺隔离症诊断的金标准.经异常供血动脉栓塞治疗肺隔离症安全,患者痛苦小,并发症少,是一种有效的治疗方法.     

骨巨细胞瘤的MRI诊断价值

目的探讨骨巨细胞瘤的MRI表现特点及其病理基础。资料与方法搜集经手术病理证实的12例骨巨细胞瘤患者资料，分析其MRI征象并与病理结果对照。结果T1WI上肿瘤实体表现为低、等信号，T2WI上为不均匀高信号，Gd-DTPA增强扫描呈中度到明显强化。此外，MRI还可显示肿瘤内坏死、出血、含铁血黄素沉着等。结论MRI能够提供比较全面的影像学信息，可提高对骨巨细胞瘤诊断的准确性。     

Maturation of Pulmonary Metastases of Wilms' Tumor after Therapy: A Case Report

A case is reported of Wilms' tumor associated with multiple pulmonary metastases histologically showing maturation of the tumor cells at 9 years after the resection of the primary tumor and intensive therapy. A huge tumor of a 22-month-old patient's right kidney was resected. The tumor was diagnosed as Wilms' tumor of mesenchymal type (stage 1), which consisted of predominantly immature mesenchymal tissue including rhabdomyoblasts, smooth muscle and fibrous tissue, and few blastemal and epithelial components. Intensive preoperative and postoperative chemotherapy with actinomycin D and vincristine and postoperative irradiation therapy totaling 16 Gy were carried out. The patient was regularly followed up uneventfully until 9 years after the surgery. On routine chest x ray at the age of 10 years 11 months, multiple pulmonary nodules were found. The excised nodules from the bilateral lungs disclosed similar histology, exclusively composed of dense collagen bundles and fibrocytes intermingled with mature striated muscle bundles. No immature tumor components were detected. The possible effect of intensive therapy in this maturation was stressed, although spontaneous benign differentiation of tumor cells cannot be excluded.     

Unique variant of partial anomalous pulmonary venous connection with intact atrial septum

Summary Partial anomalous pulmonary venous connections (PAPVCs) are rare in association with an intact atrial septum. However, the diagnosis should be considered in patients with otherwise unexplained findings of left-to-right shunt and right heart enlargement. An unusual variant is presented, which we considered unsuitable for operative repair, based on findings at catheterization. Developmental, hemodynamic, and surgical considerations are discussed.     

Role of blast cell immunophenotyping for the diagnosis and prognosis of acute myeloid leukemia.

Bone marrow blast cell antigen expression from 86 patients with de novo acute myeloid leukemias (AML) was studied and correlated with FAB classification and clinical outcome. Among a panel of 14 monoclonal antibodies routinely used for the diagnosis of acute leukemias we studied the expression of six antibodies (CD13, CD15, VIM2, CD33, CD14, CD34) of the granulomonocytic lineage and found that some of them were useful for diagnosis and/or prognosis. For FAB subclassification of AML, the CD13 or VIM2 antigen expression was of no benefit. Monocytic leukemias (M4 + M5PD + M5WD) more frequently expressed CD34 antigen (28/31) than granulocytic (M1 + M2 + M3) subtypes (33/53) (P < 0.01). Finally, the most striking differences were found with CD14 antigen expression: CD14 antigen was more frequently expressed in M4 + M5 leukemias (21/31) than in M1 + M2 + M3 subtypes (12/33) (P < 0.01). The mean percentage of CD14 positive blast cells was accordingly higher in monocytic leukemias than in granulocytic leukemias and the difference was highly significant (P < 0.0001). The CD15 antigen was more frequently expressed in differentiated leukemias (M2 + M3 + M4 + M5WD) (35/44) than in poorly differentiated forms (M1 + M5PD) (17/37) (P < 0.001). The statistical difference was higher when the mean percentage of CD15 positive blast cells were compared (P < 0.0003). Moreover these latter percentages were different in M1 and M2 subtypes (P < 0.003). The blast cell expression of CD13, CD14, CD15 or CD33 was not predictive of the length of CR or survival. Moreover, our results support previously published findings suggesting a longer overall survival duration for patients whose leukemic cells do not express the CD34 antigen (P < 0.01). We also confirm that patients with the more differentiated subtypes of AML (CD13-, CD34+) tend to survive longer than patients with the less differentiated subtypes of AML (CD13-, CD34+) (P < 0.001).     

PULMONARY RESECTION FOR METASTATIC BREAST CANCER

Background : A patient with a solitary pulmonary metastasis who had breast cancer in the past may benefit from pulmonary resection. Methods : Between 1984 and 1996, 17 patients underwent metastatectomy for metastatic breast cancer. There were 15 females and two males whose average age was 59 (range: 40–74 years). The median tumour-free interval after the primary breast-cancer operation was 5.1 years (range: 8 months-18.2 years). Sixteen patients had complete resections, which included six lobectomies and 10 lesser resections. Results : The postoperative mortality was nil and the morbidity rate was 6%. Follow-up was complete in all patients. Recurrent disease developed in four patients and two patients died of their disease. The 5-year survival was 62%. Conclusion : An aggressive surgical approach is warranted in patients with isolated resectable pulmonary metastases from breast cancer.     

HCVRNA阳性的丙型肝炎诊断和治疗探讨

HCVRNA阳性的丙型肝炎46例，均经临床和／或组织学确诊。治疗组24例用IFNa－nl或a－2b3×106IU，隔日一次；对照组22例用一般护肝药物。HCVRNA12周转阴率治疗组为83．3％，对照组为9．0％（P＜0．001）。ALT和AST复常率治疗组也优于对照组（P＜0．05）。随访观察满48周者治疗组15例中HCVRNA持续转阴11例（73．3％）．对照组5例均持续阳性。治疗组中5例做了Ⅰ～Ⅲ型HCV基因分型，结果均为Ⅱ型。同时对急、慢性丙型肝炎的发病过程和病理诊断作了讨论。     

Postoperative pulmonary complication rate and long-term changes in respiratory function following esophagectomy with esophagogastrostomy

Upper abdominal surgery has a high incidence of postoperative respiratory complications. Although operations involving a thoracic as well as an upper abdominal incision as encountered in esophageal surgery are likely to be associated with an even higher complication rate and perhaps permanent alterations of respiratory function, only a few studies have addressed this problem. We evaluated the postoperative course of patients undergoing thoracoabdominal esophagectomy with esophagogastrostomy. Twenty patients were evaluated, of whom 10 (50%) developed respiratory complications as defined by our criteria, which were the simultaneous occurrence of rectal temperature over 38 degrees C on the first postoperative day and radiographic evidence of pulmonary infiltration. Although there is no general consensus regarding the diagnostic criteria of a postoperative pulmonary complication, we were able to validate the clinical relevance of our definition by showing that these patients suffered from a more severe and more prolonged impairment of global oxygen exchange than those who did not fulfill the criteria. They also required a longer period of respiratory support (median duration of intubation 12 vs. 3 days, P less than 0.005). A comparison of the preoperative pulmonary function with that determined at least 6 months after the operation showed that only vital capacity (VC) and total lung capacity (TLC) were significantly (P less than 0.05) reduced following the operation, but not to a clinically relevant degree (VC-6%, TLC-7%).     

Pulmonary Function in Survivors of Wilms' Tumor

The respiratory status of 47 patients surviving childhood Wilms' tumor was studied. The group that had receivedflnnk irradiation (which impinges on the lower lung) (n - 17) had a sisnijGantly lower mean percent predicted for forced expiratory volume in one second, residual volume, and total lung capaci(v when compared to those who had received no irradiation (n - 23). Those patients who had received whole-lung irradiation (n - 3) had sisnijicantly lower transfn. foctor for carbon monoxide and gas transfer per unit lung volume whm compared to the nonirradiated group (n - 23). There was no sipiftiant dimue in the prevalence of respiratory symptoms between the three groups. Patients receiving any form of radiotherapy for Wilms' tumor may have abnormulities o f pulmonary function and should have pulmonary function tests performed as part o f their long-tmn follow-up.