CT导向下经皮射频消融术治疗肾上腺恶性肿瘤

目的对29例肾上腺肿瘤患者行射频消融（RFA）治疗，研究其近期局部治疗效果、不良反应和副作用。方法肾上腺肿瘤患者共29例，病灶总数31个，其中直径≤2．0cm的病灶共5个，2．1-4．0cm者18个，4．1-6．0cm者5个，≥6．1cm者3个，经RFA治疗1个月后行螺旋CT双期增强扫描评价肿瘤治疗效果。结果上述病灶经消融治疗后达到完全坏死者分别为5个、18个、3个、2个。患者无严重并发症出现。结论RFA治疗安全可靠，副作用小，是治疗肾上腺恶性肿瘤的有效方法之一。     

后腹腔镜治疗肾上腺肿瘤35例临床分析

目的总结后腹腔镜技术治疗肾上腺肿瘤的临床经验.方法采用后腹腔镜切除肾上腺肿瘤35例,男12例,女23例.年龄25岁～72岁,平均49.8岁.左侧15例,右侧20例.其中嗜铬细胞瘤5例,原发性醛固酮增多症10,柯兴氏病2例,神经节细胞瘤2例,无功能性腺瘤16例.腰部取3个套管针穿刺入路,用自制的水囊扩张器扩张后腹腔,用超声刀将肿瘤切除.结果 35例手术均成功,无中转开放手术病例.术中出血量10～500 ml,平均74 ml.病人均未输血.手术时间45～200 min,平均90 min.结论后腹腔镜手术切除肾上腺肿瘤手术效果确切,手术时间短,术中出血少,损伤小,术后恢复快,可以替代绝大多数肾上腺肿瘤开放手术.     

Thoracoscopic resection of a solitary pulmonary lymphangioma: Report of a case

We present herein the rare case of a young man who was found to have a solitary tumor in the right upper lobe of his lung by a routine chest X-ray. The tumor was removed by thoracoscopic surgery, and pathological examinations confirmed the diagnosis of a primary lymphangioma of the lung. A brief review of the available literature on this extremely rare type of benign tumor follows the case report.     

Effects of MPP+ on catecholamine levels in adrenal glands and heart of rats

The effects of MPP⁺ (2.5–20 mg/kg) on the adrenal glands and heart were investigated in rats. At various periods after s.c. drug administration the rats were decapitated and tissue catecholamine levels were determined by means of HPLC with electrochemical detection. Adrenal dopamine (DA) levels were reduced at 2–8 h after MPP⁺ administration, but this decrease was followed by an elevation after 16 h and return to the control values after one week. Three successive injections of MPP⁺ caused a statistically significant elevation in adrenal DA, one day, with a tendency to elevation four and seven days after the last injection, whereas a severe (up to 96%) decrease in heart noradrenaline (NA) was found one day after the last injection. Seven days after the last injection a 50% depletion of NA in the heart was still observed. Pretreatment with GBR 12909 (30 mg/kg, 4 h) blocked the MPP⁺ (10 mg/kg, 2 h) induced reduction of adrenal DA levels, but at the same time GBR 12909 failed to block the effects of MPP⁺ in the heart. One day after three successive daily injections of MPP⁺ (10 mg/kg each), the DA-uptake inhibitor GBR 12909 (30 mg/kg, 6 h) could still induce an increase in adrenal DA.MPP⁺ appears to lack persistent cytotoxic action in the adrenal medulla but rather to cause a transient inhibition of DA synthesis followed by a compensatory stimulation. The inhibition can be blocked by specific inhibitor of the DA-uptake mechanism, suggesting a direct effect of MPP⁺ taken up by adrenomedullary cells. The data obtained so far do not suggest any involvement of peripheral dopaminergic nerves in the action of MPP⁺ on the adrenal medulla. The long-lasting depletion of the heart NA, however, suggests a lesion of peripheral noradrenergic nerves.Part of this work was presented at 6th International Symposium on Chromaffin Cell Biology, Marburg, Germany, 18–23 August 1991 Correspondence to: M. Kujacic at the above address     

后腹腔镜手术切除肾上腺节细胞神经瘤疗效观察

目的 :探讨后腹腔镜微创手术治疗肾上腺节细胞神经瘤的适应证和可行性。方法 :采用后腹腔镜手术治疗肾上腺节细胞神经瘤患者 5例 ,其中左侧肾上腺节细胞神经瘤 2例 ,右侧 3例。结果 :5例后腹腔镜手术全部获得成功 ,4例肾上腺肿瘤为单发 ,1例为多发 (4个肿瘤 ) ;肿瘤最大直径 2 .5～ 8.0 (4 .2± 1.8)cm ;手术时间35～ 10 5 (5 9± 2 7)min ,估计出血量 10～ 30 (19± 7)ml,术后镇痛剂吗啡用量 0～ 2 0 (8± 8)mg ,2例未用镇痛剂 ;排气、恢复进食时间 1～ 3(1.4± 0 .5 )d ;术后住院时间 4～ 7(5 .4± 1.5 )d。无围手术期并发症发生。结论 :后腹腔镜手术切除肾上腺节细胞神经瘤是安全可行的 ,能充分体现腹腔镜手术创伤小、恢复快的优点。肾上腺节细胞神经瘤是腹腔镜手术很好的适应证。     

Autopsy findings in two siblings with infantile Refsum disease

Summary Recognition of adrenal atrophy during a review of autopsy findings in two sisters who died at 8 months and 3 1/2 years prompted estimation of very long chain fatty acids, phytanic acid and pristanic acid on wet liver fixed in formalin for 12 years. These were shown to be markedly increased and defects in multiple peroxisomal functions and decrease in particulate catalase were shown in cultured fibroblasts, confirming an abnormality of peroxisomal biogenesis. The patients had presented with failure to thrive, recurrent diarrohea and vomiting, poor mental development, retinal pigmentation, blindness and in the older patient deafness, with only mild dysmorphic features. Autopsy in the older patient showed adrenal atrophy, cirrhosis, and foamy histiocytes in multiple organs. The brain showed no demyelination, little cytoarchitectural abnormality, occasional perivascular histiocytes in the grey matter and meninges and prominent Purkinje cells in the molecular layer of the cerebellum. In the younger patient the changes were very subtle in spite of the marked clinical similarity. Despite the young age at death the clinicopathological features are most suggestive of infantile Refsum disease. In many situations anatomical pathology can be very useful in the recognition and study of peroxisomal disorders.     

大鼠肾上腺髓质增生MRI与病理的对比研究

目的通过 MRI 研究大鼠肾上腺髓质增生(AMH)的信号特征,并与病理结果对比,探讨 MRI 诊断大鼠 AMH 的可能性。方法雄性 SD 大鼠60只,依体重大小,采取随机排列表法随机分为 A、B、C 实验组,皮下注射利血平0.4 mg·kg~(-1)·d~(-1);a、b、c 对照组,皮下注射等量生理盐水,每组10只。A、a,B、b,C、c 组分别连续注射40、60和80 d,行肾上腺 MR 扫描,并和病理研究作对照。结果注射60 d 后 B 组髓质百分数(34.3±5.8)%高于 b 组(25.7±8.9)%(t=2.462,P<0.05),C 组(36.4±7.8)%也高于 c 组(24.8±7.9)%(t=3.104,P<0.01),利血平注射60 d 后 AMH 造模成功;MR 下 B 和 b 组、C 和 c 组肾上腺体积分别为(50.7±14.1)和(41.1±11.0)、(52.7±10.5)和(40.4±10.7)mm~3,差异有统计学意义(t 值分别为2.352、3.442,P 值分别<0.05、<0.01);MR 下中心髓质区 T_2WI 信号 B 组高于 b 组(Z=-3.786,P<0.01)、C 组高于 c 组(Z=-3.570,P<0.01);光学显微镜(简称光镜)下见 B 和 C 组髓质明显增厚,细胞数增多、密集,呈实质性片状或条索状分布,形成细胞巢;实验组部分大鼠 T_1WI 下外周皮质信号明显增高,光镜下见束状带增生,细胞呈空泡状肥大,富含脂质。结论 MRT_2WI 中心髓质区信号增高及 T_1WI 外周皮质高信号可能对于诊断大鼠肾上腺髓质增生有意义。     

超声引导下注射皮质类固醇治疗狭窄性腱鞘炎

目的 探讨超声引导下注射皮质类固醇治疗狭窄性腱鞘炎的方法及效果。方法 38例狭窄性腱鞘炎患者,按药物注射方法的不同随机分成2组。治疗组(21例)在10-MHz超声引导下向腱鞘内腱周间隙内穿刺注射醋酸强的松龙0.6 ml,对照组(17例)采用闭合穿刺法注射等量药物。注射前及随访时(注射后3周)测定疼痛强度视觉类比评分(Visual analogue score,VAS)。结果 随访时疼痛消失率治疗组为81％、对照组为53％,VAS下降值治疗组为[(6.8±1.9)x±s,下同]对照组为(5.1±3.0)。结论超声引导下将针尖穿刺于腱鞘内腱周间隙的操作简单、准确并可实时观察药物的分布,是治疗狭窄性腱鞘炎的较好方法。     

Experience of thoracoscopic extirpation of intrapulmonary lymphangioma

We report a 59-year-old woman who underwent thoracoscopic extirpation of the intrapulmonary cystic lymphangioma which was located in the subpleural space of the left upper lobe. A chest X-ray showed a solitary round nodule in the left pulmonary hilum. A computed tomography scan revealed a mass shadow at the interlobar region surrounding the interlobar pulmonary artery. A round nodule was recognized as low signal intensity on T1-weighted images by magnetic resonance imaging. There was biphasic signal intensity on T2-weighted images as well. Radiologically, we diagnosed this lesion as a benign cystic tumor in the lung. Thoracoscopic observation revealed a cystic lesion just beneath the visceral pleura of the upper lobe adjacent to the interlobular pulmonary artery. As this suggested a benign bronchogenic cyst, we performed extirpation of the cyst under thoracoscopy. After this operation, the cyst was diagnosed as an intrapulmonary cystic lymphangioma pathologically.