肾血管平滑肌脂肪瘤23例并文献复习

目的探讨肾血管平滑肌脂肪瘤的诊治方法.方法回顾性分析23例肾血管平滑肌脂肪瘤患者的临床资料并结合文献讨论其诊断与治疗问题.结果术前误诊为肾癌3例,23例均行不同手术治疗,术后病理证实为肾血管平滑肌脂肪瘤,术前选择性肾动脉栓塞或术中低温下阻断肾蒂可显著减少出血和不必要的肾切除.结论B超、CT是诊断本病的主要检查方法,彩超具有较好的良性疾病提示率,术中诊断不明者行多点取材冰冻切片具有重要意义,手术原则是尽可能保留肾单位.     

抗神经元抗体对副肿瘤综合征早期诊断的临床意义

目的 探讨抗神经元抗体抗-Hu、抗-Yo、抗-Ri抗体的检测与副肿瘤综合征早期诊断的关系。方法 采用蛋白免疫印迹分析(Western Blot)法对12例确诊为副肿瘤综合症(PNS)的患者血清及32例非PNS血清进行检测。结果 12例确诊患者血清中检测到一项或多项抗体阳性;PNS患者血清中抗-Hu、抗-Yo、抗-Ri抗体的阳性率高于非PNS对照组,差异有极显著性意义(P<0.01);正常对照组血清抗-Hu,抗-Yo,抗-Ri抗体全部为阴性。结论 抗神经元抗体抗-Hu、抗-Yo、抗-Ri抗体可作为PNS早期诊断及确诊的指标。     

血清P-选择素水平与冠脉病变严重度关系的研究

目的：探讨检测血清P-选择素水平与冠脉病变严重度的关系。方法：70冽冠D病患者，按临床诊断分为2组：急性冠脉综合症组32冽和稳定型冠心病组38例，对照组患者30例。ELISA检测各组患者血清中P-选择素水平．并比较各组间的差异；冠脉造影术对冠脉病变进行Gensini评分，并了解其与血清中P-选择素的相关性。结果：冠心病患者血清中的P-选择素水平显著高于正常对照组；在冠D病组内，急性冠脉综合症组的P-选择素水平显著高于稳定型冠心病患者，但两组冠脉病变Gemini评分无显著差别；而且冠脉病变Gemini评分与血清中P-选择素水平呈明显的相关性。结论：P-选择素可能参与了冠状动脉粥样硬化的发生和发展过程，血清P-选择素水平可能是冠脉病变严重度的一个预测指标。     

肺下野结核性空洞的X线表现：附27例分析

27例肺下野结核空洞,右侧15例,左侧12例,中内带居多。类圆形空洞25例,空洞直径1.5～6.8cm。薄壁空洞12例,厚壁空洞15例。22例为干性空洞,5例空洞内有液面。均按正规化疗方案治疗后空洞闭合。结合临床对肺下野结核性空洞的特点和鉴别诊断进行讨论。     

对116例异位妊娠的腹部超声诊断分析

目的：探讨腹部超声对异位妊娠诊断价值。方法：用腹部超声对116例异住妊娠进行手术及病理检查结果进行分析。结果：114例经手术及病理证实诊断为异位妊娠，诊断符合率为97．68％，误诊率2．32％。结论：腹部超声检查异住妊娠可给临床提供准确率很高的诊断依据，它具有简便、直观、迅速、敏感性高、无损伤及易于重复等优点，所以腹部超声应作为异位妊娠诊断的首选方法。     

发育性髋脱位的影像学研究进展

发育性髋脱位是一种常见的小儿骨科疾病。临床表现较隐匿,影像学检查对其诊断有重要价值。本文对X线、造影、超声、CT、MRI等影像检查方法对发育性髋脱位的诊断应用进行综述,探讨各种方法的优缺点及对发育性髋脱位的诊断价值。     

Benign schwannoma of the pancreas

Reported cases of intrapancreatic schwannomas have recently increased in the literature. However, none of these cases were diagnosed clearly as schwannoma preoperatively. We herein describe the clinicopathologic findings of a solitary benign schwannoma occurring in the head of the pancreas. Additionally, the differential diagnosis versus other cystic- and solid-appearing pancreatic masses is briefly discussed.     

ENDOSCOPIC OBSERVATION OF MUCOSAL SPREAD LESION OF CHOLANGIOCARCINOMA USING PERORAL CHOLANGIOSCOPY WITH NARROW BAND IMAGING

A 69‐year‐old man was admitted to Toho University Omori Medical Center complaining of icterus. Abdominal computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were suspicious of cholangioma of inferior bile duct. Peroral cholangioscopy using narrow band imaging (NBI) was performed and it was possible to diagnose the mucosal spread lesions of cholangioma. Histological findings reflected the endoscopic findings. Mucosal spread lesions of cholangiocarcinoma were successfully diagnosed using the CHF‐B260 for NBI.     

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.     

支气管肺癌伴其它部位多原发癌的影像诊断(附25例报告)

经病理确诊的527例原发性支气管肺癌(PBC)(1972～1987)中,PBC伴其它部位多原发癌(MPC)25例(4.7％)。其中双原发肺癌(DPBC)、12例(2.3％),PBC伴消化道癌6例(1.14％)。25例中共有原发癌灶52个,其中2例为3原发癌;同期组6例(其中DPBC 4例),后期组19例(其中14例间隔3年以上,内2例分别间隔14年及25年)。组织类型相同者8例,不同者4例。 25例MPC特点如下:1.55岁以上20例(80％);2.24例(96％)第2原发癌为1980年后发现;3.第2原发癌为肺癌者23例(92％);4.双原发肺癌12例(48％)。上述特点说明80年代老年人中MPC,尤其是肺癌发病率增高。 本文着重对第2原发肺癌的影像学表现和鉴别诊断进行讨论。