肺部小孤立病灶的鉴别诊断

本文对我院胸外科自1984年至1991年肺部X线片显示孤立病灶,其直径小于或等于3cm的78例住院患者作回顾性分析,提出其常见病种及鉴别诊断要点,对诊断未肯定的病灶是否立即手术要视病灶的良恶性可能性等因素来决定,特别强调医生的临床经验与分析能力对鉴别诊断的作用.     

Fluid-fluid levels in cavernous hemangioma of soft tissue

Five cases of cavernous hemangioma with fluid-fluid levels on magnetic resonance imaging and/or computed tomography are reported. The signal characteristics were those of blood and histological analysis of the fluid-fluid levels showed that they were blood-filled cavities in the tumor. Although this finding itself is not specific, it may help in confirming the diagnosis of cavernous hemangioma.     

Carcinoma of the papilla of vater: Are endoscopic appearance and endoscopic biopsy discordant?

Carcinoma of the papilla of Vater is classified as periampullary cancer representing 5% of all gastrointestinal tract malignancies. Early and accurate diagnosis is important for those patients with a tumor of the papilla, as the prognosis is more favorable than in other periampullary neoplasms. Endoscopically obtained biopsies from suspicious papillae can detect an early tumor, although even for skilled pathologists it is often difficult to differentiate carcinomas from noninvasive lesions on the basis of forceps biopsies. The purpose of this study was to assess the preoperative diagnostic accuracy of duodenoscopy appearance and biopsy in all cases with suspicion of tumor. Thirty patients with suspicion of carcinoma of the papilla of Vater and with final diagnosis established by pancreatoduodenectomy were included in this retrospective study. In each case, a comparison was made between endoscopic biopsy and duodenoscopic appearance. Duodenoscopic appearance sensitivity and accuracy for malignancy were 86% and 83%, respectively, whereas endoscopic biopsy sensitivity and accuracy were 65% and 67%, respectively. Although preoperative diagnosis of carcinoma of the papilla of Vater is useful for making therapeutic decisions, the diagnostic value of the endoscopic appearance was superior to endoscopic biopsy in this series. Presented at the 2003 American Hepato-Pancreato-Biliary Association Congress, Miami, Florida, February 27-March 3, 2003. Supported by FADA-CAPES/PROP 200J (M.L.D.).     

椎管内原发性孤立性纤维性肿瘤临床病理观察(附2例报告)

目的探讨椎管内孤立性纤维性肿瘤的临床病理特征、诊断和鉴别诊断,以期提高对该肿瘤的诊断水平。方法复习2例椎管内原发性孤立性纤维性肿瘤的临床资料,并观察其组织学特征和免疫组化标记。结果2例患者男、女各1例,年龄分别为23岁和32岁,临床表现为局部神经压迫症状。MRI示椎管内髓外硬膜内占位。组织学特征为梭形、卵圆形细胞呈束状、波浪状或旋涡状排列,富于胶原纤维及伴有分支状薄壁血管。细胞未见异型性和核分裂像。免疫组化示瘤细胞Vimentin( ),CD34( ),CD99( ),Bcl-2( ),AACT(-),Actin(-),S-100(-),EMA(-),GFAP(-),CD68(-),CD117(-),SMA(-),NF(-)。结论椎管内原发性孤立性纤维性肿瘤是一种罕见的肿瘤,诊断主要依靠病理形态学及免疫组化,并应与椎管内的其他梭形细胞肿瘤鉴别。     

超声心动图诊断原发性心脏肿瘤

目的：探讨原发性心脏肿瘤超声心动图(ECG)特征。方法：利用ECG检查42例心脏肿瘤。其中粘液瘤38例，恶性肉瘤2例，均经手术病理证实。横纹肌瘤2例，经随访证实。结果：ECG对38例粘液瘤，2例横纹肌瘤全部做出正确诊断。2例恶性肿瘤提示相应部位占位病变。粘液瘤多发生在左房，有明确的瘤蒂，肿瘤回声稀疏，活动度大。恶性肿瘤回声较强、无蒂，活动度小。横纹肌瘤多发生在室壁心肌内，呈结节状，与正常心肌间有明确的界限。结论：ECG对原发心脏肿瘤的诊断具有重要意义，可初步区分良、恶性肿瘤。     

Leberresektionen wegen primärer lebermalignome Eigene ergebnisse und literaturanalyse

Zusammenfassung Im Rahmen einer retrospektiven Untersuchung wurden 50 Resektionen wegen primärer Lebermalignome, die vom 1. 6. 1979 bis zum 31. 12. 1991 an der Chirurgischen Universitätsklinik Köln durchgeführt wurden, analysiert. Die Resektionsrate betrug 28 %. Die Kliniksletalität betrug insgesamt 22 % und konnte in den letzten 5 Jahren auf 4% gesenkt werden. Die Ein-, Dreiund Fünfjahresüberlebensraten betrugen unter Einschluß der Kliniksletalität 55%, 30% und 24%. Wichtigster Prognosefaktor war die chirurgische Radikalität. In einer Literaturanalyse wurden die Ergebnisse von 8725 Leberresektionen wegen primärer Lebermalignome, die zwischen 1980 bis 1992 publiziert wurden, untersucht. Die Resektionsrate betrug im Durchschnitt 32 ± 17%. Die Kliniksletalität konnte von 15 ± 5% (Resektionen vor 1970) auf 6 ± 2% (Resektionen nach 1980) gesenkt werden. Die Ein-, Drei- und Fünfjahresüberlebensraten betrugen 66 ± 17%, 39 ± 15% und 27 ± 10%. Bis auf eine geringere Kliniksletalität asiatischer Studien (4 % vs. 7%) waren die Resektionsraten und Langzeitergebnisse von asiatischen, amerikanischen und europäischen Studien durchaus vergleichbar. Die Langzeitprognose wird in erster Linie durch die erreichte chirurgische Radikalität sowie die Größe und Ausdehnung des Tumors zum Zeitpunkt der Resektion beeinflußt. Die Effektivität adjuvanter Therapien ist noch nicht ausreichend untersucht.

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Liver resection for primary liver tumors. Our own results and an analysis of the literature

In a retrospective study we analysed 50 resections for primary liver tumors performed between 1 July 1979 and 31 December 1991 at the Department of Surgery of the University of Cologne. The mean resectability rate was 28 %. Hospital mortality after resection was 22% and could be reduced to 4% during the last 4 years. The overall survival rates after 1, 3 and 5 years were 55%, 30% and 24% respectively. The surgical radicality is the most important prognostic factor. In a review of the literature the results of 8,725 resections for primary liver malignancies published between 1980 and 1992 were analyzed. The mean resectability rate was 32 ± 17%. The hospital mortality after resection could be reduced from 15 ± 5% (resections before 1970) to 6 ± 2 % (resections after 1980). The overall survival rates after 1, 3 and 5 years were 66 ± 17%, 39 ± 15% and 27 ± 10%, respectively. Apart from a lower hospital mortality in Asian studies (4 % vs. 7 %) the resection rates and long-term results of Asian, American and European studies were similar. Long-term prognosis predominantly depended on the surgical radicality and on the size and extension of the tumor at the point of resection. The effectivity of an adjuvant tumor therapy is not analyzed sufficiently.

     

卵巢肿瘤细胞DNA及RNA含量的定量分析及其临床意义

本资料对９３例不同性质的卵巢肿瘤细胞ＤＮＡ及ＲＮＡ含量进行了定量研究，其中５０例良性、４３例恶性。并对患者进行１～５年的随访。结果是卵巢良性肿瘤的异倍率（假阳性）为４４％，恶性肿瘤异倍率为８６．０％。以“标准ＤＩ”及“标准ＲＩ”为指标判断卵巢肿瘤性质的准确率较以“异倍性”为高，且双指标同时应用高于任一单指标：对卵巢良恶性肿瘤的诊断准确率分别为９０％和９５．３％。提出“标准ＤＩ”和“标准ＲＩ”是判断卵巢肿瘤性质的理想指标。且ＤＮＡ及ＲＮＡ含量与卵巢癌预后有密切关系。     

Primary and transplanted ENU induced rat tumors in neurooncology

In neurooncology transplanting, tumors can be used for many purposes e.g. to solve questions concerning the etiology and pathogenesis of such tumors or their management. Experimentally induced and transplanted tumors of the nervous system become reproducible in their morphology and growth parameters after about 12 subsequent intracerebral passages. During the period from the first to the 12th intracerebral generations, a simplification of the histology and a reduction of the induction times take place. Nowadays the growth behavior of such tumors can be followed by imaging methods such as MRI if specially adapted to small animals. Our results are based on the investigation of over 2350 experimentally induced tumors of the central and peripheral nervous system that were diagnosed according to the rules of human and rodent brain tumor classification and various subgroups of this sample, analyzed by electron microscopy, postmortal angiography and MRI.     

卵巢肿瘤蒂扭转的CT诊断价值探讨(附12例报告)

目的:评价CT对卵巢肿瘤蒂扭转的诊断,探讨囊壁局限性增厚对卵巢肿瘤蒂扭转的诊断价值。方法:对12例卵巢肿瘤蒂扭转的CT征象作回顾性分析,对卵巢肿瘤蒂扭转囊壁局限性增厚CT表现与文献报道的B超特征性表现双肿块声像图作对照分析。结果:本组12例病例中11例为卵巢囊性或者囊实性肿瘤,其中6例有局限性囊壁增厚,除此之外卵巢肿瘤蒂扭转还有其它许多CT征象,如卵巢肿瘤囊肿壁及囊肿内出血,附件输卵管增粗、显示,盆腔内积液,子宫位置偏位。结论:只要我们能密切结合临床,CT能对大多数卵巢肿瘤蒂扭转作出正确诊断。     

原发性小肠肿瘤诊断治疗的临床分析(附58例报告)

目的探讨原发性小肠肿瘤临床特型、病理分型及诊治经验。方法回顾性分析1993年10月。2003年10月收治的有完整资料的58例原发性小肠肿瘤病例。结果本组包括13例(22．4％)良性肿瘤，45例(77．6％)。小肠良性肿瘤均行局部肠段切除，除2例死于其它疾患外，余11例健在；小肠恶性肿瘤患者中，院内死亡6例，仅11例能行根治性肠切除，37例行化疗(总有效率83．4％)，随访33例(随访率89．5％)，存活5年以上者14例(5年生存率42．4％)，多为T细胞性非何杰金淋巴瘤。结论原发性小肠肿瘤恶性所占比例较高，缺乏特征性的临床表现及有效的诊断手段，易致长期延误诊治，预后甚差；对原因不明的腹痛、消化道出血及定位不明的腹部包块患者及早行剖腹探查是避免小肠肿瘤长期误诊、改善患者预后的可靠手段。