两例青少年卵巢生殖细胞肿瘤治疗

2008年7月至2009年8月湖北省妇幼保健院收治两例比较特殊的生殖细胞肿瘤患者接受手术治疗,现将治疗结果报道如下.     

Cardiac asystole post-exercise: a report of two cases

Two patients are described with reproducible cardiac asystole post-exercise. No structural heart disease was demonstrable. At autonomic function testing no abnormal responses were noted. Also, head-up tilt tests were normal. However, electrophysiologic testing and heart rate variability during 24-h Holter monitoring were indicative of a high vagal tone in both patients. The findings suggest that post-exertional asystole may not be due solely to a vasovagal mechanism; excessive rebound vagotonia per se may also play a role.     

Thoracoscopic resection of schwannoma: a report of two cases

We have performed thoracoscopic resection of schwannoma without intraspinal extension in two asymptomatic cases confirmed by chest roentgenogram and computed tomography: the case 1 with the tumor as large as 4.0 x 4.0 x 3.5 cm found in the paravertebral fifth Intercostal space, the case 2 with the tumor as large as 3.2 x 2.5 x 1.8 cm found on the first rib in contact with the supreme intercostal vein. In the operation of case 1, the dilated fifth intercostal vein in contact with the tumor which could not be controlled by Endo-Clip was doubly ligated by the use of Knot-Pusher. The tumor was successfully dissected from the chest wall and proved to arise from the fifth intercostal nerve. The tumor was brought into Endo-Pouch and extracted through one of the skin incisions which was minimally enlarged to accommodate the pouched lesion. In the operation of case 2, curved forceps facilitated the procedure because the tumor located near the apex of thorax. The tumor was found to originate from sympathetic nerve and removed through the minimally enlarged incision as case 1. We conclude as the following. The benign tumor found in the mediastinum or the chest wall is amenable to thoracoscopic treatment. In thoracoscopic procedure, as the operation under thoracotomy, we must acquire skills of standard operative technique, i.e., suture or ligation, because those skills are necessary when Endo-Clip or Endo-GIA cannot be used. The skin incision should be minimally enlarged finally when the specimen is extracted to minimize operative intervention.     

Fiberglass dermatitis: report of two cases

Fiberglass is widely used for insulation and as a reinforcement filling material. Handling fiberglass products may induce contact dermatitis. We report on the first two cases of fiberglass dermatitis reported in Taiwan. The first patient suffered from a severe pruritic eruption two hours after repairing a roof with wave-form ceiling boards. Erythematous maculopapules were present on both hands and finger webs. The second patient was a quality controller of printed circuit boards (PRCBs). She presented with erythematous maculopapules on the face and excoriated papules and lichenified plaques on the trunk and forearms, which had been present for two years. Scrapings of the skin lesions from both patients showed fiberglass spicules of 7.5 to 8 microns in diameter. Similar fibers were detected in scrapings from the wave-form ceiling board and PRCB. Histopathology of the second case revealed spongiotic psoriasiform dermatitis. Patch tests in case 2 with the plastics and glues series, epoxy resin and scrapings from the PRCBs were all negative. Fiberglass dermatitis may be easily misdiagnosed. Clinically, it may resemble scabies, eczematous dermatitis, folliculitis, petechiae and urticaria. A high index of suspicion is essential for a correct diagnosis.     

Ameloblastic fibro-odontoma: report of two cases

Ameloblastic fibro-odontoma is a rare odontogenic tumour. It affects young people and is usually located in the posterior jaws. Two cases of this tumour are presented: both lesions had produced an asymptomatic swelling. The histology showed the presence of an odontogenic epithelium immersed in a fibrous mesenchyme; dental hard tissues were also present. No recurrences were found after 12 and 4 years from the surgical enucleation of the tumour.     

Cervical adenitis: report of two cases

OBJECTIVES: A recent review or meta-analysis of epidemiologic studies concluded that persons with asbestos-related pleural plaques do not have an increased risk of lung cancer in the absence of parenchymal asbestosis. The reviewer inferred that this conclusion provided indirect supportive evidence for the proposition that asbestosis is a necessary precursor of asbestos-related lung cancer. The objective of the present communication is to contest these claims. METHODS: Finnish epidemiologic data and population statistics were used to estimate the apparent risk ratio of lung cancer associated with radiographic signs of pleural plaques. Power calculations were applied to compute the needed population sizes to demonstrate that the association is statistically significant. RESULTS: Unrealistically large population studies would be needed to observe the statistical relation between pleural plaques and lung cancer, quantitated as a risk ratio of 1.1, resulting from relatively low levels of environmental asbestos exposure. In realistic and valid epidemiologic studies on heavily exposed subpopulations, a two- or threefold risk can be identified. CONCLUSIONS: Uninformative studies should not be interpreted as providing suppressive evidence that pleural plaques are a noncausal risk indicator of lung cancer. Even for the null hypothesis, the inference that asbestosis is a necessary causal link between asbestos and lung cancer is illogical.     

Giant plexiform schwannoma: a report of two cases with soft tissue and visceral involvement

We report two cases of massive, solitary, plexiform schwannoma. One was a 9-cm subcutaneous lesion on the hip of a 72-year-old man who had become aware of the slow-growing tumor 50 years earlier; the other is the first reported plexiform schwannoma to arise in a visceral organ: it arose in the ascending colon of a 54-year-old man and exhibited a dumbbell configuration with submucosal and subserosal components. Neither patient had neurofibromatosis or schwannomatosis. Both tumors were well-circumscribed and multinodular, and both showed a plexiform architecture. Microscopically, the nodules were composed primarily of Antoni A tissue, replete with nuclear palisading and Verocay bodies. Examination by immunohistochemistry and electron microscopy demonstrated the features of well-differentiated Schwann cells; nodules were surrounded by attenuated, residual perineurium. Both patients followed a benign clinical course, without recurrence or metastasis. Neither the large tumor size nor the unusual locations affected the biologic behavior of these neoplasms. A massive plexiform schwannoma must be distinguished from a malignant peripheral nerve sheath tumor and from a plexiform neurofibroma, a tumor prone to malignant transformation.     

Bacillus cereus pneumonia in premature neonates: a report of two cases

The first publication to summarize the occupational diseases of musicians was Ramazzini's Diseases of Tradesmen in 1713. While there was sporadic interest in performing arts medicine during the 1800s, the first book devoted to the subject, Singer's Diseases of the Musical Profession, was published in 1932. During the 1960s and 1970s, both physicians and performers became more interested in arts medicine. When pianists Gary Graffman and Leon Fleisher publicly discussed their career-ending hand problems in the early 1980s, a huge, previously unknown group of injured musicians was brought to light. Since that time, publication in the field has dramatically increased, numerous conferences have been held, and clinics catering to the needs to performers have been set up in various large cities. Although we still do not have all the answers to the problems faced by performing artists, arts medicine is now a recognized discipline, reaching out to performers, arts educators, arts administrators, and instrument manufacturers.     

Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases

In May 1993, the US Food and Drug Administration (FDA) granted product approval for the first female condom made of polyurethane. It provides some protection against sexually transmitted diseases (STDs), but the data are limited on the effectiveness of the Reality Vaginal Pouch against STDs. Female condom users have a relatively high pregnancy rate. FDA requires the label for Reality to stress that latex condoms for men are most effective against STDs and HIV/AIDS. Men who are sensitive to rubber can use condoms made of sheep intestine or cecum (brand names: Fourex and Lambskin). These nonrubber male condoms prevent pregnancy, but do not prevent HIV transmission. A specialist in contact dermatitis suggests that rubber sensitive men use a nonrubber condom directly over the penis and then cover that condom with a rubber condom to protect against HIV transmission. A nonlatex thermoplastic elastomer has been used to make male condoms since the early 1990s, but FDA has yet to approve it. A recent article suggests that a thermoplastic elastomer may be the only choice for rubber sensitive males. FDA approval will increase the availability of a nonlatex thermoplastic elastomer condom. The contact dermatitis specialist reviews and follows up on other articles he has written over the last 20 years. Topics include ethylene oxide burns in hospitalized patients, paraben paradox, benzocaine as a contaminant in sunscreens containing glyceryl PABA, sensitivity to nickel, misuse of a patch test to detect hypersensitivity to mercury amalgam dental fillings, permanent destruction of the fingernails due to an allergic reaction to an acrylic nail preparation, and dermatitis due to visual display units.     

Renal cell carcinoma in a horseshoe kidney: report of two cases

We report 2 patients with renal cell carcinoma in a horseshoe kidney. A renal tumor was diagnosed during evaluation of right humeral metastatic cancer of unknown origin in case 1 (64-year-old male) and gross hematuria in case 2 (54-year-old male). Both patients underwent radical nephrectomy with division of isthmus and retroperitoneal lymph node dissection. The tumors were staged pathologically as pT2bpN0pV0pM1(oss) and pT3pN0pV1bM0, respectively. Only 27 cases of renal cell carcinoma developed in a horseshoe kidney, including the present two cases, have been reported in the Japanese literature. The blood supply to the horseshoe kidney and its evaluation by preoperative angiography were discussed.     

Bilateral Achilles tendon rupture: a report on two cases

Two cases of traumatic bilateral Achilles tendon rupture are reported. One of the patients was a healthy middle-aged man, who had been an active national-level gymnast 20 years earlier. He had not suffered any complaints of Achilles tendons before. The ruptures occurred when, after a sauna, he showed his guests a vault forwards, which he had been able to perform easily. This time the landing took place on the toes, causing a high peak stretch to the calf muscles and Achilles tendons. The total rupture of both Achilles tendons was treated surgically, with an excellent result 2 days after the trauma. End-to-end suturation and a fascial flap plasty were made on both sides. No macroscopic degeneration could be detected on the rupture sites. He was allowed to walk freely 6 weeks after the surgery. The second case was a 54-year-old woman, who had suffered from Achilles tendinitis and peritendinitis for 2 years. Both tendons had been surgically treated, and severe adhesions and local degenerative changes had been found. The tendon rupture occurred when she injured her left ankle while getting out of the car. Two days later she fell at home, because of the weakness of the left side, and consequently the right Achilles tendon was injured. She was treated conservatively for 10 days, before the surgery was performed. Both tendons were ruptured and an extensive degeneration of the area was observed. The right side suffered from a rerupture, which was again treated surgically. After surgery the recovery was slow, but the final result 3 years later was moderate. Neither of the patients had any systemic diseases.     

Oral teratoma (epignathus) with intracranial extension: a report of two cases

Epignathi are unusual congenital tumours presenting as oropharyngeal masses, often resulting in rapid asphyxia following birth. Occasionally, intracranial extension of the tumour is present, and two such cases are described. The presence of this complication, diagnosable by ultrasound examination, indicates that aggressive surgical treatment is inappropriate.     

Synovial sarcoma of the vulva: a report of two cases

We report two cases of synovial sarcoma arising in the vulva. The patients were 30 and 37 years old and presented with a painless mass that was interpreted clinically as a cyst. The tumors were 2.0 and 1.2 cm in greatest diameter. Histologically, they were composed of epithelial cells forming solid nests and gland-like and papillary structures surrounded by spindle-shaped cells. Immunohistochemically, the epithelial cells stained for cytokeratin and the spindle-shaped cells for vimentin. Ultrastructurally, the epithelial cells had prominent intercellular junctions and narrow microvilli and were separated from the spindle-shaped cells by a basal lamina. The spindle-shaped cells were closely apposed with focal intercellular contacts. One tumor recurred locally 3.5 years after excision, but the patient was alive and well 1 year after a re-excision and radiation therapy. The other patient was alive and well 4 years after an excision. These tumors are the first reported examples of synovial sarcoma arising in the vulva.     

Trigeminal neurinomas in infants: report of two cases

Two cases of trigeminal neurinoma in two infant girls aged 3 and 6 months are reported. Both presented with temporal cranial vault bulging at birth. The 6-month-old patient suffered onset of focal fits 1 month before admission and her neurological examination revealed no abnormalities. The 3-month-old patient had right exophthalmus and a subcutaneous fronto-orbital plexiform neurofibroma at birth. Neurological examination disclosed a sensory deficit of the first trigeminal nerve division. She also had a family medical history of von Reckling-hausen's disease. The incidence of trigeminal neurinomas in children is reviewed. The patients in these two cases are the youngest recorded; the cases are the only ones reported in infants. Clinical, radiological, and therapeutic aspects are discussed.     

Wernicke's encephalopathy and dialysis: report of two cases

Wernicke encephalopathy is considered a complication of dialytic therapy, but there are few reports of this complication. We report a 57 years old man and a 45 years old woman, with grade IV renal failure, who after acute peritoneodialysis and chronic hemodialysis respectively, had a confusional syndrome that responded to the administration of thiamine. CT scans in both patients discarded abnormal blood collections or new cerebrovascular episodes. The man bad two previous cerebrovascular episodes, a severe anemia that was corrected, angina and an episode of arrhythmia during the dialytic procedure previous to the confusional episode. The woman had an acute uremic syndrome and a concomitant urinary tract infection during the confusional episode. Wernicke encephalopathy must be suspected in patients in dialysis with confusional episodes.