OVERVIEW FOR THE DIAGNOSIS AND TREATMENT OF GALLBLADDER CARCINOMA

Objective. To improve the recognition of diagnosis and treatment of gallbladder cancer. Methods. Retrospective analysis of 52 cases of gallbladder carcinoma in our hospital from 1988 to 1998. Results. Preoperative diagnostic rate was 90.3%, of which 12 cases (23%) were early stage of carcinoma. The total operation resection rate was 55.8%, for which only 17.8% were advance stage of carcinoma. Conclution. The early diagnosis is the key factor of increasing treatment successful rate. The following are the symptoms that raise our special attention to carcinoma of gallbladder: ( 1 ) Age over 50 have recurrent eholecysfitis and with past history of gallstone; (2) Congenital malformation of bile duct; (3) Local thickening and irregularity of gallbladder,gall; (4) Polypoid lesion larger than lem inside gallbladder; (5) Atrophic gallbladder; (6) Intraluminal stone of gallbladder does not move when change in body position; (7) Regional lymph node enlargement.     

Multiviszerale Resektion des fortgeschrittenen kolorektalen Karzinoms Multivisceral resection in advanced colorectal carcinoma

Zusammenfassung Berichtet wird über die operative Behandlung von 1232 Patienten mit einem kolorektalen Karzinom aus dem Zeitraum 1.09.1984 bis 1.01.1990. Entsprechend einer Resektionsquote von 90,3 % wurden 1112 Patienten (kurativ: n = 917, palliativ: n = 195) reseziert. Bei 82 Patienten war wegen Organüberschreitung des Tumors eine multiviszerale Resektion von einem oder mehreren benachbarten Organen (69mal kurativ, 13mal palliativ) notwendig. Komplikationsraten (26,7% zu 27,5 %) und die 30-Tageletalität (3,4% zu 2,9 %) waren in beiden Gruppen der kurativ and kurativ erweitert resezierten Patienten gleich. Die Berechnung der Fünfjahresüberlebensrate ergab für die kurativ resezierten Patienten ohne Erweiterung einen Wert von 58% gegenüber 55 mit Erweiterung. Auch die Subgruppenanalyse ergab keinen Unterschied in den einzelnen Stadien. Die Ergebnisse lassen den Schlul zu, da bei gleicher Komplikations-und Letalitätsrate die kurativ erweiterte Resektion von pT3- and pT4-Tumoren gleiche Spdtergebnisse wie die entsprechende Behandlung von nicht erweitert resezierten pT3-Tumoren erwarten lät. Die Daten zeigen, da eine Infiltration von Nachbarorganen durch ein kolorektales Karzinom nicht als Inoperabilitätskriterium gelten darf.

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From 1 September to 1 January 1990, a total of 1232 patients underwent surgery for colorectal cancer. Resection was performed on 1112 (90.3%) patients. It was curative in 917 cases and palliative in 195. Multivisceral resection was necessary 82 times because of tumour infiltration of adjacent organs (curative: 69 cases; palliative: 13 cases). The complication rate (26.7% vs 27.5%) and mortality rate (3.4% vs 2.9%) were similar to those for curative resections without multivisceral extension. The 5-year survival rate was also similar in the two groups (58% vs 55%). These results show that curative multivisceral resections can lead to the same long-term results as conventional curative resections. These data are encouraging, and tumour infiltration of neighbouring organs should not be taken to demonstrate inoperability.

     

Volumetric reconstruction and stereotactic computer assisted resection in intracerebral lesions

Summary Since 1990 112 patients have undergone Stereotactic resection of intra-axial tumoural lesions with volumetric reconstruction, using the Kelly-Goerss system. Stereotactic integration of CT, angiographic and particularly MRI information, together with three-dimensional information of the lesion, provide an innovative evaluation of the most appropriate surgical approach, even for each single patient. The main limitation of this surgical method is in cases where the infiltrating part of the tumour is pre-eminent, while it can allow macroscopically complete resection of well circumscribed lesions, almost independently of their location and volume. Some technical aspects of Stereotactic resection of brain tumours are discussed in the light of our experience.     

Acquired hyperoxaluria and haematuria in children

Two children with extensive ileal resection are reported. They developed gross haematuria of non-glomerular origin, without stones or nephrocalcinosis. Previous reports indicate that acquired hyperoxaluria is common in children with a variety of intestinal disorders. Our patients had hyperoxaluria. We think that hyperoxaluria may be the cause of haematuria through a pathogenetic mechanism similar to the one ascribed to haematuria secondary to hypercalciuria and hyperuricosuria.     

The transurethral resection syndrome

The transurethral resection syndrome ("TUR syndrome") is caused by absorption of electrolyte-free irrigating fluid, and consists of symptoms from the circulatory and nervous systems. The clinical picture is inconsistent and the syndrome is easily confused with other acute disorders. Mild forms are common and often go undiagnosed, while severe forms of the TUR syndrome are rare and potentially life-threatening. The pathophysiology is complex but includes four mechanisms: circulatory distress from the rapid absorption of electrolyte-free irrigating fluid, adverse effects of glycine, dilution of the protein and electrolyte concentrations of the body fluids, and disturbance of renal function. The treatment of the TUR syndrome consists of general life support and in specific treatment directed towards hypotension, hyponatraemia and anuria. Methods to lower the uptake of irrigating fluid are widely used and probably reduce the incidence of the TUR syndrome. However, patient safety can be guaranteed only if the absorption is monitored. An irrigating fluid containing tracer amounts of ethanol can be used for this purpose. This permits the uptake of fluid to be indicated by measuring the concentration of ethanol in the patient's exhaled breath.     

Multiple mononeuropathy as the initial presentation of systemic lupus erythematosus — nerve biopsy and response to plasma exchange

Summary A total of 15 patients affected by idiopathic dystonia (7 with generalized and 8 with focal or segmental dystonia) were subjected to therapy with bromocriptine at low doses, pimozide and trihexyphenidyl. The symptoms were evaluated by giving a progressive score in relation to the intensity of the dystonic symptom to each of the body segments involved by the dystonia. Bromocriptine did not significantly modify the dystonia. Pimozide showed a slight nonsignificant improvement of the dystonic symptoms. Trihexyphenidyl was effective in the generalized dystonias, in agreement with previous reports in the literature. The variation in the pharmacological results could be due to the diversity of the dystonic syndromes, which comprise cases that are different in age at onset, site of dystonic symptoms, and evolution.

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Zusammenfassung Fünfzehn von idiopathischer — und zwar 7 von generalisierter und 8 von fokaler und segmentarischer — Dystonie befallenen Patienten unterzogen sich verschiedenen pharmakologischen Behandlungen mit kleinen Mengen Bromocriptine, Pymozide und Triesifenidile. Die Symptome wurden durch eine fortlaufende Punktzahl bezeichnet, so daß deren Schätzung von der Intensität des Symptoms Dystonie in jedem einzelnen befallenen Körperteil abhing. Die Dystonien wurden durch Bromocriptine nicht bedeutend geändert.Pymozide führte zu einer geringeren, doch unbedeutenden, Besserung der dystonischen Symptome.Triesifenidile wirkte auf die generalisierten Dystonien, in Übereinstimmung mit einigen Literaturangaben.Die Veränderlichkeit der pharmakologischen Ergebnisse wurde auf die Verschiedenheit der dystonischen Syndrome zurückgeführt, unter denen man Fälle versammelt, die sich durch Anfangsalter, Sitz der dystonischen Symptome und Entwicklungsart voneinander unterscheiden.

     

The rotational component in the dynamics of the C2–3 spinal segment

Summary The technique of the PA axial projection of the arches of the upper cervical vertebrae into the occipital foramen and the normal findings, are described. The influence of maximum forced anteflexion at the craniocervical junction and rotation of the head on the relations of atlas and axis is demonstrated. It seems that in this position rotation at atlasaxis level is restricted and partly transmitted to the C_2–3 segment. Thus, selective clinical examination of the rotational component of the dynamics at C_2–3 can be achieved and the pathological restrictions of movement can be assessed.     

颈总动脉切除术10例回顾性分析

目的 探讨颈总动脉切除术的适应症和术前准备的一般规律。方法 对我院自1986年～2003年17年问的10例颈总动脉切除术病例进行回顾性分析。其中年龄22～59岁，急诊手术4例，选择性颈动脉切除6例。结果 急诊手术中2例出现中枢神经系统并发症，选择性手术组中1例出现中枢神经系统并发症。除1例因脑转移癌死亡外，随访均健在。结论 行不重建血管的颈总动脉及分歧部切除术，高龄患者须严格掌握适应症，须无脑血管疾病史，术前须进行Matas试验，要有侧支循环建立的客观依据；对年轻患者(30岁以下)可适当放宽手术指征。     

Clinical significance of interstitial collagen deposition at the invading edge in oral cancer: Immunohistochemistry for type I collagen

Background Changes in interstitial collagen in human oral cancer have not yet been fully studied. We examined the relationship between the degree of interstitial collagen deposition at the invading edge of the tumor, and the clinical and pathologic findings in oral squamous cell carcinoma. We also investigated the therapeutic implication of the changes in distribution patterns of collagen deposition by comparing biopsy specimens and surgical specimens. Methods Immunohistochemical staining was performed by the streptavidin-biotin method using antibody against human type I collagen for visualizing interstitial collagen in 50 biopsy and 45 surgical specimens. Results Carcinomas with scanty interstitial collagen in biopsy specimens tended to have highly malignant characteristics. Large carcinomas with scanty deposition both in biopsy and surgical specimens were likely to have positive resection margins in spite of radical surgery. Conclusion Immunostaining patterns for type I collagen of oral squamous cell carcinomas can provide information of importance in determining safe resection margins.