胆胰手术后假性动脉瘤诊断及治疗

胆胰疾病病人经外科手术、介入或内镜治疗后发生迟发性大出血时,救治困难、病死率高,而术后假性动脉瘤形成和破裂是主要原因。胆胰手术后假性动脉瘤成因复杂多样,瘤体破裂出血前临床症状隐匿。从致病机制源头预防假性动脉瘤形成、重视前哨出血等特征性临床症状,将会有效确保胆胰疾病病人围手术期安全性,提高术后迟发性大出血的救治成功率。     

Algorithmic Approach to Fibroinflammatory Sinonasal Tract Lesions

Fibroinflammatory lesions of the sinonasal tract are one of the most common head and neck lesions submitted to surgical pathology. When the fibroinflammatory pattern represents the lesion (i.e., not surface reactive ulceration), an algorithmic approach can be useful. Separated into reactive, infectious, and neoplastic, and then further divided based on common to rare, this logical progression through a series of differential considerations allows for many of these lesions to be correctly diagnosed. The reactive lesions include chronic rhinosinusitis and polyps, granulomatosis with polyangiitis, and eosinophilic angiocentric fibrosis. Infectious etiologies include acute invasive fungal rhinosinusitis, rhinoscleroma, and mycobacterial infections. The neoplastic category includes lobular capillary hemangioma, inflammatory myofibroblastic tumor, and NK/T-cell lymphoma, nasal type. Utilizing patterns of growth, dominant cell types, and additional histologic features, selected ancillary studies help to confirm the diagnosis, guiding further clinical management.     

Prechiasmatic Reordering of Fibre Diameter Classes in the Retinofugal Pathway of Ferrets

This study examines the distribution of fibre diameter classes at various sites along the retinofugal pathway of adult ferrets. Light microscopic observations were made on semi-thin sections, and regional fibre diameter spectra were constructed from diameter measurements taken from electron micrographs of thin sections of the intraorbital optic nerve (2.5 mm from the optic disc), the intracranial optic nerve (1 mm rostral to the fusion of the nerves), and the optic tract (just caudal to the optic chiasm).
Whereas diameter types are relatively evenly distributed behind the eye in the postoptic nerve, they begin to segregate along its prechiasmatic course. Within this prechiasmatic region, coarse and fine calibre fibres are confined increasingly to more ventral locations in the nerve, leaving a dorsal band populated predominantly by intermediate calibre fibres. In conjunction with this redistribution of axon size classes, the fascicular arrangement of axons which is present distally, changes to a non-fascicular organization. The prechiasmatic organization of fibre types approximates that found in the optic tract where the coarse and fine calibre fibres lie further ventrally towards the pial surface.
The prechiasmatic region can be viewed as a region of transition where the order of fibres in the nerve (retinotopic) starts to change to that present in the optic tract (chronotopic), resulting in the first-born beta cell axons becoming segregated dorsally, and rostral to the coarse and fine calibre classes which segregate at further caudal locations. Further, since the sorting of fibres according to diameter appears before the fibres reach the optic chiasm, the segregation of diameter classes is not dependent on the chiasmatic sorting of fibres according to their crossed or uncrossed course.     

恶性梗阻性胆管炎29例临床分析

我院在1978～1988年间共收治胆管及壶腹周围肿瘤162例,其中29例有恶性梗阻性胆管炎,占同期收治的胆管及壶腹周围肿瘤的17.9％,其中表现为急性梗阻性化脓性胆管炎10例。病变依次为乳头部癌、胰头癌、胆管癌和肝门部转移癌。部分伴有胆石与胆道手术史。通过B超、经皮肝穿刺胆道造影术、胆道引流术,以及逆行胰胆管造影术而确诊。对发病情况、临床特点、诊治进行了讨论。