弧形荷包PPH联合硬化注射治疗直肠前突的临床应用

为探讨弧形荷包PPH联合硬化注射治疗直肠前突的临床疗效，对以临床症状、病史、直肠指诊、排粪造影为诊断依据的27例直肠前突患者行该术式治疗。结果显示，治愈17例（62．96％）；显效7例（25．93％）；有效2例（7．41％）；无效1例（3．70％）；总有效率96．30％（26／27）。结果表明，弧形荷包PPH联合硬化注射治疗直肠前突有较好疗效。     

RPH联合硬化剂注射术治疗痔疮60例分析

目的:比较自动痔疮套扎（RPH）联合硬化剂注射术和传统外剥内扎术的临床疗效差异。 方法：对我院肛肠外科收治的120例混合痔病人，60例行RPH+硬化剂注射（观察组），60例行传统的外剥内扎术（对照组），分析比较两组的疗效、术后并发症及病人满意度等。结果：观察组的手术时间、平均住院时间明显低于对照组（P<0.05），术后疼痛、术后水肿、出血等并发症的发生率明显低于对照组(P<0.05)，治愈率两组比较无显著性差异（P>0.05）。结论：RPH联合硬化剂注射术治疗痔病，操作简单，安全有效，术后并发症少，疗效确切。     

硬化剂注射治疗食管曲张静脉模型的病理变化

目的 研究3种不同硬化剂的致硬化作用和其局部毒性.方法 36只新西兰兔的肝前性门脉高压食管静脉曲张模型,随机地分为5%鱼肝油酸钠组、1%乙氧硬化醇组和消痔灵注射液组,每组12只.经腹给兔行硬化剂注射治疗,分别于注射后72h、10天、20天将兔处死,肉眼观察管溃疡发生率并行组织学检查.结果5%鱼肝油酸钠组、1%乙氧硬化醇组的溃疡发生率分别为83.3%和58.3%,组织学上以“液化性坏死”为特征;消痔灵注射液组的溃疡发生率仅为16.7%,组织学上以“凝固性坏死”为特征.凝固性坏死可不经液化而为肉芽组织逐渐包裹、吸收,产生理想的纤维化.结论 消痔灵可能成为高效、低并发症的理想硬化剂.     

Complementary role of helical CT cholangiography to MR cholangiography in the evaluation of biliary function and kinetics

To explore the potential role of computed tomographic cholangiography (CTC) in relation to magnetic resonance cholangiography (MRC) in cases in which knowledge of biliary kinetics and functional information are important for therapeutic decisions, 31 patients (14 men and 17 women) underwent MRC followed by CTC. We examined nine post-cholecystectomy cases with right upper quadrant abdominal pain, six cases with a previous biliary-enteric anastomosis and clinical evidence of cholangitis, eight biliary strictures with pain or symptoms of cholangitis, four cases with strong clinical evidence of sclerosing cholangitis, three cases with suspected post-laparoscopic cholecystectomy bile leakage, and one case with chronic pancreatitis and a common bile duct stent associated with cholangitis. In relation to MRC, CTC provided additional biliary functional information as follows: abnormal biliary drainage through the ampulla in 7/9 cholecystectomy cases, impaired drainage in 3/6 biliary-enteric anastomoses, and complete obstruction in 2/8 biliary strictures. CTC diagnosed early sclerosing cholangitis in 4/4 cases and confirmed suspected bile leakage in 1/3 post-laparoscopic cholecystectomy patients, and the patency of the biliary stent in the patient with chronic pancreatitis. Thus, CTC provides clinically important information about the function and kinetics of bile and complements findings obtained by MRC.     

Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial

Local injections of the sclerosing substance Polidocanol has been demonstrated to give good clinical results in a pilot study on patients with chronic Achilles tendinopathy. In this study, 20 consecutive patients (9 men and 11 women, mean age 50 years) with chronic painful mid-portion Achilles tendinopathy were randomised to injection treatment with either Polidocanol (5 mg/ml) (group A) or Lidocaine hydro-chloride (5 mg/ml) + Adrenaline (5 g/ml) (group B). Both substances have a local anaesthetic effect, but Polidocanol also has a sclerosing effect. The patients and the treating physician were blinded to the substance injected. The short-term effects were evaluated after a maximum of two treatments, 3–6 weeks apart. Before treatment, all patients had structural tendon changes and neo-vascularisation demonstrated with US and colour doppler. Under US and colour doppler-guidance, the injections targeted the area of neo-vascularisation just outside the ventral part of the tendon. For evaluation, the patients recorded the severity of Achilles tendon pain during tendon loading activity, before and after treatment, on a VAS. Patients satisfaction with treatment was also assessed. At follow-up (mean 3 months) after a maximum of two treatments, 5/10 patients in group A were satisfied with the treatment and had a significantly reduced level of tendon pain (p<0.005). In group B, no patient was satisfied with treatment. In the pain-free tendons, but not in the painful tendons, neo-vascularisation was absent after treatment. After completion of the study, treatment with Polidocanol injections (Cross-over in group B and additional treatments in group A) resulted in 10/10 and 9/10 satisfied patients in group A and B, respectively. In summary, injections with the sclerosing substance Polidocanol have the potential to reduce tendon pain during activity in patients with chronic painful mid-portion Achilles tendinopathy.     

A case of sclerosing lymphocytic lobulitis of the breast associated with diabetes mellitus

Background: The benign breast disease sclerosing lymphocytic lobulitis is thought to result from autoimmune diseases causing insulin-dependent diabetes mellitus (IDDM) due to insulinitis. In cases of sclerosing lymphocytic lobulitis accompanied by IDDM, the clinical term “diabetic fibrous breast disease” has been proposed. Methods: A case of sclerosing lymphocytic lobulitis of the breast is described. Results: The patient was a 43-year-old woman diagnosed with non insulin-dependent diabetes mellitus (NIDDM) 8 years previously. Insulin therapy was thought to be necessary because treatment with glibenclamide was not effective. She visited our facility complaining of a lump in her right breast that was 5 cm in diameter, painless, rock-hard, discrete, and irregularly outlined. Biopsy was performed because breast cancer was strongly suggested by its hardness and its irregular internal echo on ultrasonography. Histopathological findings demonstrated marked stromal sclerosis and lymphocyte infiltration in the perivascular and perilobular areas. Sclerosing lymphocytic lobulitis was diagnosed. Conclusions: Referring physicians should avoid performing unnecessary repeated biopsies by recognizing this disease entity, which often occurs bilaterally.     

Inflammatory Pseudotumor of the Spleen:Report of a Case with an Immunohistochemical Study

A 81-year- old Japanese man with a splenic inflammatory pseudotumor is described. The pseudotumor was un changed in size after one year of observation. Macro-scopically, the lesion was a firm well-circumscribed 5.5X 5×5cm mass showing a yellowish-white cut surface. Histologically, it was composed of abundant mixed inflammatory infiltrates, predominantly UCHL-1(+) T and L26(+) B lymphocytes, plasma cells containing various immunoglobulin subtypes, and S 100 protein(+), and lysozyme and NCA(+) histiocytes, with a sclerotic stroma. Small numbers of eosinophils, neutrophils and foamy macrophages were admixed. The patient has remained disease-free for 14 months after splenectomy. Only ten splenic inflammatory pseudotumors have been reported in the literature. This paper adds an additional case, together with details of immunohistochemical polyclonality of each inflammatory cell population, confirming that this disease is a nonspecific inflammatory change. Acta Pathol Jpn 42:376–381, 1992.     

Sclerosing hemangioma of the lung in a young woman with cutaneous melanoma: the role of electron microscopy in preventing an erroneous diagnosis of metastasis

A young woman with a melanoma of the left forearm was found to have a right lung mass. This was initially interpreted as metastatic melanoma on the basis of clinical, radiographic, and light microscopic features, together with positive staining of tumor cells with antibody HMB-45. Electron microscopic examination performed for confirmation of the diagnosis revealed no evidence of melanocytic differentiation. Instead, there were features suggestive of the alternative diagnosis of sclerosing hemangioma (SH). This diagnosis was confirmed with additional immunocytochemical stains. To the authors' knowledge this is the first report of HMB-45 positivity in SH. This case illustrates a potentially disastrous diagnostic pitfall in interpreting lung tumors in patients with melanoma, and the vital role of electron microscopy in resolving conflicting and/or misleading immunocytochemical results.     

Zur Pathologie der Xanthofibrogranulomatose

Summary Two cases are described of an extensive sclerosing lesion involving the retroperitoneum, mesentery, mediastinum and epicardium which is referred as Xanthofibrogranulomatosis. The term was chosen on histological criteria: granulomatous infiltration of chronic inflammatory cells without necrosis, proliferation of spindle-shaped, lipid-laden histiocytes, aggregation of xanthomatous cells and increased production of reticulin and collagenous fibers. Furthermore the name suggests that the lesion tends to be generalized although it does not represent a true neoplasm. In nearly all cases the changes are localized in the retroperitoneal adipose tissue extending to the renal hilus and enveloping the aorta and kidneys; other organs such as adrenals and pancreas are also often surrounded. The frequent cardiac manifestations (14 of 22 cases) with sclerosis of the epicardial fat especially in the right atrioventricular region are conspicous. Moreover involvement of organs may be found, e.g. the lungs or the posterior lobe of the pituitary gland in our cases. Generally the spread of the process shows a striking relation to large blood vessels. However, the distribution lacks uniformity. The characteristic localization and histology allows the distinction of Xanthofibrogranulomatosis from other well known disorders such as Ormond's, retroperitoneal fibrosis, panniculitis (Weber-Christian disease) and histiocytosis X (Hand-Schüller-Christian). The etiology and pathogenesis of Xanthofibrogranulomatosis are uncertain. Perhaps an autoimmune mechanism involving the fat cell membrane may play a part in the genesis of this chronic inflammatory sclerosing process. As long as no rational specific therapy exists, we must interpret the xanthofibrogranulomatous lesion as a slowly but irreversibly progressing disease which is clinically comparable with a malignant tumor.