Video‐assisted segmental resection of an intrapulmonary bronchogenic cyst mimicking a middle mediastinal cystic tumor

We report a case of an intrapulmonary bronchogenic cyst that radiologically mimicked a cystic tumor of the middle mediastinum. During video‐assisted thoracoscopic surgery, the lesion was confirmed to be in the lung parenchyma rather than in the mediastinum. A video‐assisted thoracoscopic anterior basal segmentectomy was eventually performed, and an intrapulmonary bronchogenic cyst was the diagnosis based on histology.     

乳腺癌真空辅助旋切术后保乳手术的可行性

目的：探讨胃癌患者术前中性粒细胞/淋巴细胞比值（neutrophillymphocyteratio,NLR）对术后预后的影响。方法：术后病理确诊胃癌患者根据术前NLR分为低NLR组（＜2.8,n=165）和高NLR组（≥2.8,n=66）,比较两组患者临床病理因素和术后总生存期（overallsurvival,OS）及无病生存期（diseasefreesurvival,DFS）,分析预后影响因素。结果：高NLR组淋巴结转移数多、TNM分期晚、清蛋白低（P＜0.05）。高NLR组1年、2年及5年OS低于低NLR组（75.8%、60.6%、48.5%vs87.9%、77.6%、61.2%,P=0.039）;高NLR组中位DFS短于低NLR组（16个月vs49个月,P=0.000）。Cox单因素分析显示：高NLR、浸润深度深、淋巴结转移数多、TNM分期晚、年龄大、低清蛋白是影响OS及DFS的不良预后因素（P＜0.05）;Cox多因素分析显示：TNM分期是影响OS的独立预后因素（P=0.000）,TNM分期、NLR是影响DFS的独立预后因素（P=0.000,P=0.024）。结论：术前NLR是影响胃癌DFS的独立预后因素,对OS的预后意义有待进一步探讨。     

Highly metabolic thrombus of the portal vein： ^18F fluorodeoxyglucose positron emission tomography/computer tomography demonstration and clinical significance in hepatocellular carcinoma

AIM： To assess the ability of ^18F-fluorodeoxyglucose positron emission tomography/computer tomography （^18F-FDG PET/CT） to differentiate between benign and malignant portal vein thrombosis in hepatocellular carcinoma （HCC） patients.
METHODS： Five consecutive patients who had HBV cirrhosis, biopsy-proven HCC, and thrombosis of the main portal vein and/or left/right portal vein on ultrasound （US）, computer tomography （CT） or magnetic resonance imaging （MRI） were studied with ^18F-FDG PET/CT. The presence or absence of a highly metabolic thrombus on ^18F-FDG PET/CT was considered diagnostic for malignant or benign portal vein thrombosis, respectively. All patients were followed-up monthly with US, CT or MRI. Shrinkage of the thrombus or recanalization of the vessels on US, CT or MRI during follow-up was considered to be definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered to be consistent with malignancy. ^18SF-FDG PET/CT, and US, CT or MRI results were compared.
RESULTS： Follow-up （1 to 10 mo） showed signs of malignant thrombosis in 4 of the 5 patients. US, CT or MRI produced a true-positive result for malignancy in 4 of the patients, and a false-positive result in 1. ^18F-FDG PET/CT showed a highly metabolic thrombus in 4 of the 5 patients. ^18F-FDG PET/CT achieved a true-positive result in all 4 of these patients, and a true-negative result in the other patient. No false-positive result was observed using ^18F-FDG PET/CT.
CONCLUSION： ^18F-FDG PET/CT may be helpful in discriminating between benign and malignant portal vein thrombi. Patients may benefit from ^18F-FDG PET/CT when portal vein thrombi can not be diagnosed exactly by US, CT or MRI.     

CT测量肝硬化肝脏大小的研究

目的探索肝硬化患者肝脏大小的CT评估方法及其变化的规律。方法 CT检查并测量365例肝硬化患者的肝脏体积（LV）、肝脏最大平面和肝门平面面积。比较男女、各年龄组之间的差异。对肝脏体积和最大平面或肝门平面面积之间的关系进行相关分析和多重线型回归分析。结果男性肝硬化患者肝脏总体上显著小于女性,230例男性和135例女性肝硬化患者的LV分别为756.02±199.06cm3和1075.05±368.88cm3（P〈0.001）;最大平面面积分别为123.18±18.80cm2和163.27±25.39cm2（P〈0.001）;肝门平面面积分别为118.05±18.93cm2和152.94±24.10cm2（P〈0.001）。随着年龄的增大肝脏的体积、最大平面面积和肝门平面面积均有缩小趋势。肝脏的体积与最大平面面积、肝门平面面积密切相关,尤其是LV与最大平面面积之间的相关系数在0.747以上。通过线性回归评估肝脏的大小,基本能反映肝脏的容量。结论肝硬化患者肝脏大小在男女性别间、不同年龄段间具有一定的规律。肝硬化患者肝脏的体积与最大平面面积、肝门平面面积具有密切的相关性,尤其是肝脏最大平面面积可用于临床评估肝脏的大小,方法更为简便。     

老年性胃间质瘤的螺旋CT表现及其病理基础

目的探讨老年性胃间质瘤的螺旋CT表现,以提高对该病的认识。方法收集资料完整的老年性胃间质瘤47例,分析其螺旋CT表现及病理基础。结果良性11例,交界性9例,恶性27例;腔内型5例,腔外型30例,腔内外型12例。良性、交界肿瘤CT平扫呈圆形或类圆形均匀密度软组织肿块,肿瘤直径常小于5cm,增强扫描病灶呈中度以上的较均匀强化;恶性病变CT平扫为较大的不规则或分叶状肿块,其内有出血、坏死、囊变及钙化,增强扫描肿物呈不均匀强化,其内坏死、囊变区无强化,动脉期瘤体旁可见排列成簇状或线状增强的细小血管,静脉期病变强化程度高于动脉期。结合手术病理,CT对病变定位准确率为100％,定性准确率达91％。结论螺旋CT能很好反映老年性胃间质瘤的生长方式及病理基础,存肿瘤的检出、判断肿瘤与周围器官的关系、有无转移及良恶性鉴别等方面均有重要价值。     

CT在漏斗胸诊断和微创Nuss手术中的作用

目的 探讨CT在漏斗胸术前诊断和微创Nuss手术中的应用.方法 2002年7月到2008年9月648例NUSS手术病例均行术前CT检查,分析病人胸廓的畸形程度、分型、与周围脏器的关系和发现合并症,对手术进行指导和评价.结果 648例均顺利完成手术,CT分度为中度73例(11.27%),重度575例(88.73%).对称型407例(62.81%),偏心型83例(12.81%),不均衡型158例(24.38%).术前发现其他合并症116例(17.90%),CT检查确诊55例,占发现合并症的47.41%;55例中28例同期进行了手术.结论 CT能有效评价胸廓的畸形程度、分型、指导手术的入路、减少并发症的发生,并能进一步发现其他先天畸形等合并症,还是漏斗胸微创Nuss手术的术前常规检查和重要评估手段.     

肾病综合征合并血栓栓塞症临床特点分析

目的:回顾性分析肾病综合征(NS)不同肾脏病理类型合并血栓栓塞症患者临床表现和实验室检查特点。方法:42例NS合并血栓栓塞症患者均行肾活检明确诊断,其病理类型包括微小病变(MCD)9例(21.4%)、局灶节段性肾小球硬化(FSGS)10例(23.8%)和膜性肾病(MN)23例(54.8%)。分析患者发生血栓栓塞症时的临床表现,血液和尿液等实验室检查特点。血栓栓塞症的确诊方法为:肾血管、下腔静脉、肺动脉以及腹部其他血管行CT血管成像(CTA);四肢深静脉、颈内静脉采用压迫型超声;磁共振血管成像(MRA)检查头颅血管。结果:(1)本组患者年龄9岁～65岁,三组患者平均年龄、性别分布无统计学差异,MN组平均年龄(36.2±17.0)岁,较文献报道特发性MN患者平均年龄水平低(P0.05)。(2)NS病程中的任何阶段均可发生血栓栓塞症,MCD组多见于NS复发阶段,MN组多为NS治疗无效者。(3)全身深静脉均可发生血栓,常见部位:肾静脉血栓(RVT)21处、肺动脉栓塞(PE)15处和下腔静脉10处;90.5%RVT和60%PE患者为MN组;MN组平均每例发生血栓部位数(1.87处)显著高于MCD(1.1处)和FSGS(1.1处)。(4)镜下或肉眼血尿、腰痛和肾脏体积增大为RVT患者的常见临床症状;PE患者主要临床症状为胸痛、呼吸困难和咯血;少数患者为无症状性VTE。(5)实验室检查结果提示MN组血白蛋白高于MCD和FSGS组,而胆固醇、血红蛋白水平,血小板数量和红细胞压积均低于MCD和FSGS组;MCD和FSGS组抗凝血酶III值降低尤其明显(均低于MN组)。D二聚体阳性率86.5%。结论:NS合并血栓栓塞症十分常见,不同病理类型,其发生血栓的时间、部位和实验室检查特点有所不同,少数患者发生VTE可无临床症状,高危患者D二聚体阴性亦不能排除血栓可能,需进一步筛查。     

Pregnancy and ��-thalassemia: an Italian multicenter experience

Background

Recent advances in the management of thalassemia have significantly improved life expectancy and quality of life of patients with this hemoglobinopathy, with a consequent increase in their reproductive potential and desire to have children.

Design and Methods

We describe the methods of conception and delivery, as well as the course and outcome of pregnancy including transfusions, iron overload and chelation in 46 women with thalassemia major (58 pregnancies) and in 11 women with thalassemia intermedia (17 pregnancies). Conception was achieved after gonadotrophin-induced ovulation in 33 of the women with thalassemia major and spontaneously in all of those with thalassemia intermedia.

Results

Among the women with thalassemia major, 91% of the pregnancies resulted in successful delivery of 45 singleton live-born neonates, five sets of twins and one set of triplets. No secondary complications of iron overload developed or worsened during pregnancy. When considering only the singleton pregnancies, the proportion of babies with intrauterine growth retardation did not differ from that reported in the general Italian population. The high prevalence of pre-term births (32.7%) was mostly related to multiple pregnancies and precautionary reasons. Pregnancy was safe in most women with thalassemia major or intermedia. However, women with thalassemia intermedia who had never previously been transfused or who had received only minimal transfusion therapy were at risk of severe alloimmune anemia if blood transfusions were required during pregnancy.

Conclusions

Provided that a multidisciplinary team is available, pregnancy is possible, safe and usually has a favorable outcome in patients with thalassemia. In women with hypogonadotropic hypogonadism, gonadal function is usually intact and fertility is usually retrievable.