后腹腔镜手术治疗肾上腺囊肿15例报告

目的探讨后腹腔镜手术治疗肾上腺囊肿的方法及临床意义. 方法 2000年3月～2004年5月我院对15例肾上腺囊肿均采用后腹腔镜手术治疗.扩张后腹膜间隙成功后,紧靠膈下纵形切开肾周筋膜,肾周筋膜内分离肾上极和肾上腺周围的脂肪组织,超声刀或电刀在肾表面分离肾脏上极和肾上腺.游离肾上腺行肾上腺部分切除或全切除. 结果 15例手术均获成功,其中肾上腺部分切除术12例,肾上腺全切术3例.手术时间(49.0±31.4)min,术中出血量(31.6±28.7)ml,住院时间(4.1±1.4)d.除1例术后伤口皮下气肿外,无其他术后并发症.15例术后随访(18.5±1.0)月(12～36个月),无一例复发. 结论后腹腔镜手术可作为肾上腺囊肿的首选治疗方法.     

Image features of two rare mediastinal tumors: schwannoma of intrathoracic phrenic nerve and clear cell chondrosarcoma of the rib

The current report focuses on two patients of the same age who presented similar appearances on initial anteroposterior chest images. Follow-up images showed superoanterior and superoposterior mediastinal lesions. The first patient with noninvasive cystic thymoma was suspected before surgery, while the pathologic diagnosis was intrathoracic phrenic nerve schwannoma. The second patient was with an asymmetric, dumbbell-shaped paravertebral tumor over T3 and T4 on the left side. The preoperative…     

Neuroimaging in Pineal Tumors

BACKGROUND AND PURPOSE: The authors report radiological findings in 11 tumors in the pineal region, which were histologically diagnosed as germinomas, pineocytomas pineoblastomas, ependymomas, teratomas, and astrocytomas. METHODS: Computed tomography (CT) was performed in seven patients and magnetic resonance imaging (MRI) was performed in all patients. RESULTS: CT showed a solid or solid/cystic mass with variable contrast enhancement. MRI showed a heterogeneous mass, with hypointense signal on T1 and iso/hyperintense signal on T2-weighted images (WI) and gadolinium enhancement. Extension to adjacent structures occurred in five patients and spread through the cerebral spinal fluid (CSF) in two. CONCLUSIONS: Pineal region tumors have no pathognomonic imaging pattern. MRI and CT are complementary in diagnosis and are important to determine localization, extension, and meningeal spread.     

氨苯砜综合征诊治探讨——附6例报告

目的：探讨氨苯砜综合征的诊治要点：方法：对6例氨苯砜综合征患者的临床资料进行回顾性分析。结果和结论：6例氨苯砜综合征患者均为中青年，从服药到出现症状的时间较长，为9～55日.6例患者均以高热起病，起病急骤、凶险，病初均有麻疹紫癜样皮疹，皮疹多形，严重者出现尼氏征阳性或阴性的大疱和（或）全身性红皮病样皮疹；均有浅表淋巴结肿大；多数患者有血液系统损害；并均有肝损害：确诊后及时停氨苯砜，给予足量肾上腺皮质激素和（或）大剂量免疫球蛋白静脉注射，以及支持对症处理，住院12～80（中位数53）日，4例痊愈，1例病情得到控制，另1例因治疗第2日自动出院放弃治疗，死于肝功能衰竭？提示氨苯砜综合征需要及时、正确处理，否则预后不良.     

Long-term survival in children under 3 years of age with low-grade astrocytoma

Objective The purpose of this study is to analyze clinical aspects and disease-free survival (DFS) in children less than 3 years of age diagnosed with low-grade astrocytoma. Methods In a period of 24 years (1980–2004), a total of 43 (5.4%) children were registered with these characteristics. Twenty-three patients had pilocytic astrocytoma, 18 diffused, and 2 mixed. Thirty-one (72.1%) children had incomplete surgical tumor resection and 12 (27.9%) had a complete tumor resection. Twelve (27.9%) patients had cranial radiotherapy and 17 (39.5%) received chemotherapy. Overall survival was recorded in 23 (53%). DFS was 50% at 250 months of follow-up for the whole group. DFS for the supratentorial group was 60% at 250 months, whereas, for the infratentorial, it was 22% at 120 months (p = 0.008). Conclusion The only favorable prognostic pattern was the supratentorial presentation. Radiotherapy and chemotherapy did not alter the outcome.     

放大内镜及实体镜检查结肠肿瘤性病变(附139例报告)

目的探讨如何通过放大内镜观察到的大肠粘膜腺管开口类型发现早期大肠癌及癌前病变。方法2001年8月~2002年2月结肠镜检查139例大肠病变,采用内镜下粘膜染色技术,结合放大内镜、实体显微镜观察腺管开口分型(pit分型)并与病理诊断对照,pit分型采用工藤分型。结果139例患者中发现大肠息肉124例,进展期癌9例,侧向发育型肿瘤(LST)型病变5例,ⅡC病变1例。LST直径10~50 mm,其中ⅢL型1个,Ⅳ型4个。本组放大内镜与病理、实体镜诊断符合率较高。结论大肠腺管开口对于判断肿瘤性、非肿瘤性病变以及早期大肠癌具有重要意义,如发现有Ⅴ型腺管开口时则高度提示早期癌的可能。     

右侧肾上腺肿瘤的辅助显露方法

目的：探讨右侧肾上腺肿瘤的手术技巧。方法：术中切断8例患者的部分肝脏韧带，向左旋转肝脏，充分显露肿瘤及肝后腔静脉。结果：8例均获完整切除，效果较好。结论：切断部分肝脏韧带，有助于显露肿瘤，可免除胸腔联合切口，提高切除率，降低手术风险。     

Rapidly enhancing hepatic hemangiomas at MRI: Distinction from malignancies with T2-weighted images

The purpose of this study is to describe a subset of atypical hepatic hemangiomas that enhance rapidly and diffusely and to determine whether heavily T2-weighted images could distinguish between atypically enhancing liver hemangiomas and hypervascular malignancies. A retrospective search of MR records identified seven patients with liver hemangiomas that demonstrated diffuse early enhancement and 23 patients with biopsy-proven malignant liver lesions that were hypervascular on dynamic gadolinium-enhanced MR images. Quantitative analysis of signal intensity measurements was performed on the T2-weighted images, heavily T2-weighted (TE < 140), and dynamic gadolinium-enhanced images. Blinded reader comparison of the T2-weighted images and gadolinium-enhanced images was performed. Hypervascular hemangiomas enhanced to a greater degree than hypervascular malignant liver lesions on the early phase gadolinium-enhanced images. Perilesional parenchymal enhancement was demonstrated in five cases of rapidly enhancing hemangiomas. Signal intensity and contrast-to-noise ratios on the heavily T2-weighted images of the hemangiomas were significantly greater than that of the hypervascular malignant lesions (P < .05). Hemangiomas were differentiated from the hypervascular malignant liver lesions with high accuracy (97–100%) by three blinded readers based on the T2-weighted images. A subset of hemangiomas have atypical rapid diffuse enhancement on dynamic gadolinium-enhanced images. These atypical hemangiomas can be distinguished from hypervascular malignant liver lesions on T2-weighted MR images.     

Surgical treatment of metastatic lung tumors — Recent changes in techniques and indications

Between 1969 and 1995, 180 patients underwent complete resection of lung metastases during initial thoracotomy at our institute, involving the resection of 917 pulmonary nodules at 202 thoracotomy procedures. The overall postmetastasectomy 5- and 10-year survival rates were 46% and 30%, respectively. Of 111 patients who underwent segmentectomy and/or local excision, 57 had multiple metastases, 39 of whom were treated by Nd:YAG laser after 1986, and 18 by conventional procedures before 1985. The average number of tumors resected per patient treated with the Nd:YAG laser was significantly greater than that of those treated with conventional procedures. However, the survival curve of the laser-treated group was better than that of the laser-nontreated group. Moreover, slightly better survival was achieved in patients operated on after 1992 compared with those operated on before 1991. We conclude that the laser technique may be warranted to afford complete resection of metastases and adequate pulmonary reservation in combination with a selected approach for thoracotomy under the exact detection of tumor localization using the most recent high-quality computed tomography (CT) scan. Furthermore, a one-stage operation to control synchronous intra- and extrapulmonary malignamcies may become a possible option in combination with selective adjunctive therapy.