原发性乳腺肉瘤67例临床治疗分析

目的:探讨原发乳腺肉瘤的合理治疗模式.方法:对1995 年2 月至2000年12月收治的67例乳腺肉瘤的临床资料和治疗情况进行回顾性分析.67例乳腺肉瘤患者分实验组40例(分叶状囊肉瘤组)和对照组27例(非分叶状囊肉瘤组),病理高分级(Ⅲ级以上)和(或)肿瘤直径的≥5CM患者分单纯手术组21例和综合治疗组25例,比较两者之间的近期生存率.结果:实验组和对照组1年、3年、5年总体生存率(OS)分别为:100%、97.50%、80.00%.和96.30%、74.07%、44.44%.实验组和对照组1年、3年、5年OS对比有统计学意义.非分叶状囊肉瘤组中单纯手术组和综合治疗组1年、3年、5年OS分别为:95.23%、71.43%、42.85%和100%、92.00%、72.00%.1年、3年OS对比无统计学意义,5年OS对比有统计学意义.结论:原发于乳腺的分叶状囊肉瘤单纯手术治疗疗效较好,非分叶状囊肉瘤预后较差;病理高分级(Ⅲ级以上)和(或)肿瘤直径的≥5CM乳腺肉瘤患者单纯手术治疗疗效较差,综合治疗可改善预后.     

组织细胞肉瘤六例临床病理学及免疫组织化学特点分析

目的 探讨组织细胞肉瘤(HS)的病理学特点、特异性标志物的意义及相关的鉴别诊断.方法 采用EnVision免疫组织化学方法检测6例发生于不同部位的HS.结果 6例HS中男性5例,年龄1～65岁,中位年龄18岁,女性1例,77岁.组织形态学:肿瘤细胞弥漫浸润,大小不一,部分区域细胞呈上皮样,胞质丰富嗜酸性,核圆形或不规则形,核仁大而嗜酸,核分裂象多见,个别区域可见双核、多核及瘤巨细胞,6例肿瘤细胞间质中均可见多少不等的炎性细胞.免疫表型:6例患者肿瘤细胞CD68、溶菌酶(1ysozyme)、LCA阳性,4例灶性细胞S-100阳性或弱阳性,2例个别细胞CD43阳性、1例个别细胞CD45RO阳性,Ki-67阳性率30%～90%,而CD21、CD35、CD4、CD1a、MPO、CD30、CD3、CD20、ALK、HMB45均阴性.结论 HS诊断相对比较困难,需结合肿瘤的镜下形态学改变及免疫表型.LCA、CD68、lysozyme是比较特异性的免疫表型,对HS的诊断及鉴别诊断有较大意义.     

40例肿瘤PICC置管临床护理

目的:探讨临床护理在肿瘤PICC置管中的应用效果.方法:选择我院2009年1月至2011年1月收治的行PICC置管化疗的肿瘤患者80例,随机分为两组,对照组40例采取常规护理,观察组40例在常规护理的基础上实施综合护理干预,对两组临床结果进行回顾性比较分析.结果:观察组治疗依从性明显优于对照组,并发症发生率明显低于对照组组,差异均有统计学意义(P<0.05),观察组导管发生脱落1例,对照组3例.结论:随着医学护理模式的改变,在肿瘤PICC置管的患者中行综合护理干预措施,可作为一种有效的辅助治疗手段,明显降低了并发症的发生率,提高了患者治疗依从性,具有十分重要的临床意义.     

心包原发性滑膜肉瘤1例报道

Primary pericardial sarcomas are extremely rare. We report a case of 19 year old male who presented with cough,dyspnoea, and orthopnea. Investigations and exploratory thoracotomy revealed a large pericardial mass. Surgical debulking of the tumor was performed and the histopathological examination was compatible with synovial sarcoma. The tumor was unresectable due to its invasion and adhesion to mediastinal structures. Hence patient was started on palliative chemotherapy (adriamycin and ifosfamide based). Patient showed an initial symptomatic response but later on there was a clinical progression and died within six months of his diagnosis.     

牙髓炎根管治疗的临床观察和疗效分析

目的:探讨了根管治疗牙髓炎的临床疗效.方法:回顾性分析了我院自2009年 01月 ~ 2010年12月期间采用根管治疗的107例牙髓炎患者,143 颗患牙的临床资料,分析治疗前后临床症状、体征以及X 线检查,判定治疗效果.结果:前牙充填良好率91.07%;前磨牙充填良好率78.78%;磨牙充填良好率52.38%;前牙功率96.43%;前磨牙治疗成功率91.11%;磨牙治疗成功率80.95%,本组病例成功率合计90.21%,失败率为9.79%.结论:根管治疗方法疗效显著,缩短疗程,减少复诊次数,值得临床推广.     

40例血液透析患者中心静脉置管的临床应用

目的:寻找最佳的深静脉置管血管通路的建立方法.方法:分析40例深静脉置管的患者,置管部位包括颈内静脉及股静脉.封管方法为纯肝素封管.结果:40例患者接受了深静脉置管,平均置管保留时间为72.5天,并发症发生率为22.5%.颈内静脉置管平均保留时间为93.2天,并发症发生率为18.2%,股静脉置管平均保留时间为34.7天,并发症发生率为30%,与颈内静脉置管相比有显著性差异(P<0.05).结论:颈内静脉置管为血液透析治疗首选的临时血管通路.     

糖尿病足96例临床分析

1 临床资料1.1 一般资料 1998年1月-2004年12月本院收治糖尿病足(diabetic foot,DF)患者96例,均为2型糖尿病患者.其中男性67例,女性29例.年龄41～76岁,平均58.5岁.有糖尿病家族史者28例,有周围神经病变者96例,有血管病变者78例,有肾病及视网膜病变者43例.足病诱因:睡火炕及热水袋取暖或热水洗脚时烫伤;甲沟炎及足部皮肤疱疹感染未予重视;鞋小或皮鞋挤磨伤;修脚时不慎划伤;长期走路磨损及意外足外伤等.足部坏疽共35例,其中足趾坏疽21例(60%).坏疽类型中湿性坏疽21例,干性坏疽9例,混合性坏疽5例 .     

胎膜早破64例临床分析

目的:探讨胎膜早破难产与母婴结局的关系.方法:选取2009年1月-2010年1月在我院分娩发生胎膜早破的产妇64例为观察组,同期分娩未发生胎膜早破的产妇70例为对照组,比较两组分娩方式及母婴并发症情况,并进行统计分析.结果:剖宫产率、早产率、新生儿窒息率及新生儿肺炎发生率比较,胎膜早破组均显著高于对照组,差异有统计学意义(p<0.05).结论:胎膜早破对分娩方式及母婴结局有重要影响,临床对于胎膜早破者要及时发现处理以改善分娩结局,降低母婴并发症的发生.     

100例小儿肺炎临床分析

本文通过对１００例小儿肺炎的诊断与疗效观察，论述了根据不同病例，由于采取综合治疗措施，均取得了十分满意的疗效。同时作者依据实际临床经验，重点对冬眠疗法、肺炎心衰、液体疗法及抗菌素疗法进行了初步的探讨。     

Two new cases of liver angiosarcoma: history and perspectives of liver angiosarcoma among plastic industry workers

In this report of two new cases of liver angiosarcoma (ASL) among plastic industry workers, the authors present the history and perspectives of this problem. The first cases of ASL have been registered since 1974, and in 1984, the European register of angiosarcoma was founded. In this register, 11 cases of ASL and one case of haemangiopericytoma have been registered from Croatia, all from a single plastics plant near Split. Two new cases of ASL (in retired autoclave cleaners, who were exposed to a concentration of 500-1000 ppm vinyl chloride monomer (VCM) during the working process) in the same plant are represented. They were detected with combined techniques of ASL detection, and both are still alive. The diagnoses have been histologically confirmed: one of them was surgically treated with segmental liver resection. The appearance of new cases of ASL confirms the perspective presented in the last report by the same authors.     

Elective mutism: an analysis of 100 cases

OBJECTIVE: An extended series of 100 children with elective mutism (EM) was clinically analyzed. METHOD: The total sample included two subgroups of clinically referred children at different locations and a subgroup of nonreferred children with EM. The study was based on comprehensive item sheets and, in the nonreferred sample only, the Child Behavior Checklist. RESULTS: EM is a rare disorder in the referred child psychiatric samples. It typically starts at preschool age, is more common in girls, and is seen in all social strata. A background of migration and early developmental risk factors is also quite common. Premorbid speech and language disorders play a role in one third of the clientele, and three quarters of children with EM had behavioral abnormalities during infancy and preschool age. School and unfamiliar people create the social context in which children with EM most frequently do not speak. Shyness and internalizing behavior problems are the most common personality features in EM, and comorbid diagnoses are quite frequent. CONCLUSION: This large series of affected children has identified the most typical features of EM and thereby extends the limited knowledge of this rare disorder of childhood.     

Delayed endolymphatic hydrops: an analysis of 12 cases

Delayed Endolymphatic Hydrops (DEH) is a clinical entity which is characterized by an early phase with a profound sensorineural hearing loss in one ear. After a prolonged period of time (from 1 to 68 years) a late phase of the disease appears with different otologic symptoms. The ipsilateral type of endolymphatic hydrops appears in the deaf ear with consequent episodic vertigo. The contralateral type develops symptoms of endolymphatic hydrop in the previously normal ear, with the onset of fluctuating hearing loss and/or episodic vertigo. This paper is a review of 12 cases of DEH (7 ipsilateral and 5 contralateral, age ranging from 19 to 79 years). Diagnosis was established on the basis of clinical history and the results of audio-vestibular investigations, specifically designed to detect signs of endolymphatic hydrops (including the glycerol-test and neuroradiological imaging of the cerebello-pontine angle). In 8 patients the levels and frequency of anti-collagen I-II-IV-V, anti-laminin autoantibodies, complement, Ig and immuno-complexes were measured. Viral infections (measles, mumps, influenza) were thought to have caused the early phase in 6 cases. In the entire group of 12 patients the delay between the onset of the ear loss and vertigo averaged 12 years. In the group of the ipsilateral DEH, caloric tests showed in 5 cases a reduced or absent response of the deaf ear. About contralateral DEH, caloric tests showed bilateral reduced response in 2 cases, and, in 3 cases, a decreased response only in the previously normal ear. Regarding immunological study, an abnormal level of Ig and Complement was detected in 3 patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hepatic cystadenoma: an unusual presentation

A 53-yr-old woman with a history of hepatic cystadenoma 25 yr before presented with a simple hepatic cyst, which evolved over 9 yr into a complex cystadenoma with septations and internal bleeding. She was treated with a left hepatectomy. Review of the literature shows that hepatic cystadenomas, although rare, frequently can recur years later and have potential for malignant transformation. Histologic similarities of one variant with ovarian stroma raises interesting possibilities regarding the origin of these lesions. The best treatment results are obtained with radical excision.     

胃肝样腺癌:1例报告

Objective:We reported a case with AFP produced gastric hepatoid adenocarcinoma. Methods:A male patient,77 year-old, was admitted to our hospital due to an unreasonable elevation of serum AFP. The tumors were revealed by PETCT,but until the tumors were removed during the surgery, we did not recognize the primary lesion was the gastric cancer.Results:Radical distal gastrectomy was performed. The gastric lesion was confirmed by histology as a hepatic adenocarcinoma in its early stage. Conclusion:The rare etiology of the AFP elevation should be kept in mind in clinic, extrahepatic lesions should be excluded.     

Hepatic amebiasis: an unusual clinical presentation

BACKGROUND: Painful liver enlargement with fever are common signs of hepatic ambiasis. Exceptionally, atypical signs may also occur including symptoms suggesting renal sepsis. CASE REPORT: An 18-year-old woman from the New Caledonia was hospitalized in metropolitan France for suspected right-sided acute pyelonephritis. Urinalysis was normal and the kidney ultrasound suggested the need for an abdominal CT-scan which evidenced a voluminous 10-cm abscess pus. Serology for amebia was positive, confirming the diagnosis of hepatic amebic abscess. Outcome was rapidly favorable with intravenous anti-parasite treatment amebic abscess. Outcome was rapidly favorable with intravenous anti-parasite treatment and percutaneous drainage. DISCUSSION: Atypical signs of hepatic ambiasis may mislead diagnosis. The absence of a fetid odor at puncture helps guide diagnosis, confirmed by serology. Percutaneous drainage can hbe proposed for voluminous abscesses or if the risk of extrahepatic complications is eminent.     

Dermatofibrosarcoma protruberans: analysis of eight cases in an African population

Eight cases of dermatofibrosarcoma protruberans seen in the University College Hospital, Ibadan, Nigeria between 1960 and 1972 are reviewed. The condition is rare in this population and affects young adults of both sexes. All were treated by wide excision and skin grafting with no recurrence at follow-up. The apparently low incidence being reported may be due in part to the inconsistent histological pattern of the lesion. Clinicians are urged to be more aware of this condition when a cutaneous, nodular or multiobulated tumor is encountered.     

Complications of laparoscopic cholecystectomy in China: an analysis of 39,238 cases

OBJECTIVE: To investigate the complications of laparoscopic cholecystectomy in China. METHODS: All Chinese articles about laparoscopic cholecystectomy published between April 1994 and November 1995 were identified through CMCC (Chinese Medical Computerized Contents). From more than 600 titles, 105 articles were screened for analysis. Another 21 articles from the 6th Biliary Surgical Congress and 300 cases from the General Hospital of PLA were added. A total of 39,238 cases of laparoscopic cholecystectomy from 91 hospitals were studied. RESULTS: Severe complications of laparoscopic cholecystectomy were identified in 409 (1.04%) patients, including bile duct injury (in 0.32% of patients), postoperative cystic duct leak (0.11%), postoperative bile leak (0.20%), peritoneal abscess (0.07%), bowel injury (0.06%) and postoperative hemorrhage (0.1%). Fourteen postoperative deaths (0.04%) resulted from operative injury. CONCLUSIONS: The data demonstrate that laparoscopic cholecystectomy is an operation associated with low morbidity and mortality rate, but bile duct injury is still a major problem. Complications of laparoscopic cholecystectomy can be minimized by improving operative procedure.