ObjectiveTo study the clinical manifestation, radiographic characteristics, and treatments of reactive lymphoid hyperplasia(RLH) of liver. MethodsThe clinical data and treatment process of 1 patient with RLH of liver in our hospital was analyzed retrospectively, and the other 49 cases reported in English literature were reviewed. ResultsThere were 33 pieces of case reports found in PubMed database. For all 50 patients, there were 45 female(90%) and 5 male(10%) patients, and the mean age was(57.6±14.0) years(15-85 years). Only 8 patients(16%) were discovered with multiple mass, the rest of them were solitary mass(84%). Of the 50 patients, 6 patients(12%) were discovered because of bellyache, 2 patients(4%) were discovered during operation, 2 patients(4%) were discovered by pathological examination after liver transplantation, 1 patient(2%) was discovered during autopsy, 39 patients were discovered during examination or reexamination. The tumors were located in the right lobe for 25 patients(50%), in the left lobe for 15 patients(30%), in the both lobes for 4 patients(8%), and in the caudal lobe for 1 patient(2%), while 5 cases(10%) were not given in the articles. Eleven patients(22%) had the history of malignancy, 15 patients(30%) were concomitant with autoimmune disease, and 5 patients(10%) were concomitant with virus hepatitis infection. Thirty-six patients(72%) were diagnosed as malignancy preoperatively, and 43 patients(86%) underwent surgical resection. ConclusionsRLH of liver is an extremely rare and benign condition which presents a female predilection and often concomitants with autoimmune disease and history of malignancy. Considering the risk of malignant transformation, surgical resection is recommended and further researches are necessary for better understanding of this disease.
ObjectiveTo study the therapeutic efficacy of stereoelectroencephalography (SEEG)-guided radiofrequency thermo-coagulation ablation (RF-TC) in the treatment of tuberous sclerosis (TSC) related epilepsy and to investigate the prediction of the therapeutic response to SEEG-guided RF-TC for the efficacy of the subsequent surgical treatment. MethodsWe retrospectively analyze TSC patients who underwent SEEG phase II evaluation from January 2014 to January 2023, and to select patients who underwent RF-TC after completion of SEEG monitoring, study the seizure control of patients after RF-TC, and classify patients into effective and ineffective groups for RF-TC treatment according to the results of RF-TC treatment, compare the surgical outcomes of patients in the two groups after SEEG, to explore the prediction of surgical outcome by RF-TC treatment. Results59 patients with TSC were enrolled, 53 patients (89.83%) were genetic detection, of which 28 (52.83%) were TSC1-positive, 21 (39.62%) were TSC2-positive, and 4 (7.54%) were negative, with 33 (67.34%) de novo mutations. The side of the SEEG electrode placement: left hemisphere in 9 cases, right hemisphere in 13 cases, and bilateral hemisphere in 37 cases. 37 patients (62.71%) were seizure-free at 3 months, 31 patients (52.54%) were seizure-free at 6 months, 29 patients (49.15%) were seizure-free at 12 months, and 20 patients (39.21%) were seizure-free at 24 months or more. 11 patients had a seizure reduction of more than 75% after RF-TC, and the remaining 11 patients showed no significant change after RF-TC. There were 48 patients (81.35%) in the effective group and 11 patients (18.65%) in the ineffective group. In the effective group, 22 patients were performed focal tuber resection laser ablation, 19 cases were seizure-free (86.36%). In the ineffective group, 10 patients were performed focal tuber resection laser ablation, only 5 cases were seizure-free (50%), which was a significant difference between the two groups (P<0.05). ConclusionsOur data suggest that SEEG guided RF-TC is a safe and effective both diagnostic and therapeutic treatment for TSC-related epilepsy, and can assist in guiding the development of future resective surgical strategies and determining prognosis.
目的 探讨结节性甲状腺肿与甲状腺癌并存时的诊治方法。 方法 回顾性分析我院1961～2000年手术治疗的4 622例结节性甲状腺肿病例中169例并存甲状腺癌患者的临床资料。 结果 患者平均年龄（42.71±12.96）岁，病程平均19.15年； 43例出现短期内颈部肿块快速长大，32例有气管受压症状，27例出现声音嘶哑； 行超声检查105例，提示甲状腺癌者52例； 行放射性核素扫描检查38例，24例显示甲状腺内凉结节或冷结节； 行术前细针穿刺细胞学检查18例，找到癌细胞11例。术前确诊率为12.43%。术中行快速病理检查57例，55例诊断为甲状腺癌。 结论 在结节性甲状腺肿临床表现的基础上出现颈部肿块增长迅速、气管受压、声音嘶哑等症状时应高度怀疑结节性甲状腺肿与甲状腺癌并存； 甲状腺彩色超声多普勒、甲状腺核素扫描、细针穿刺细胞学等检查对诊断本病有重要意义； 术前检查怀疑甲状腺癌者术中应行快速冰冻切片病理检查，可有效避免再次手术。
目的探讨再次手术治疗复发性结节性甲状腺肿的安全性及有效性。 方法回顾性分析2004年1月至2012年12月期间于笔者所在医院行再次手术治疗的48例复发性结节性甲状腺肿患者的临床资料。 结果本组48例患者中，再次手术行甲状腺全切除术33例，行甲状腺近全切除术15例。术中显露喉返神经32例（61条），均无喉返神经损伤发生；未能显露喉返神经16例，其中有2例发生喉返神经损伤，损伤率为12.5%，高于显露喉返神经者（P＜0.05）。术后均无永久性低钙血症发生，17例（35.4%）发生暂时性低钙血症。术后均获访0.5～8.0年，平均4.3年，无复发。 结论复发性结节性甲状腺肿再次手术行甲状腺全切除或近全切除术是安全可靠的，预防术后并发症的关键是熟悉甲状腺解剖和精细手术操作。
ObjectiveTo analyze the clinical efficacy and safety of rapamycin in the treatment of Tuberous sclerosis complex ( TSC ) complicated with refractory epilepsy, and to provide scientific basis for the clinical treatment of this disease.MethodsRetrospective analysis was performed on 22 children with TSC complicated with refractory epilepsy admitted to Henan People's Hospital from 2017 to 2019, including 11 males and 11 females who met the inclusion criteria, with an average age of (27.91±36.92) months. They were treated with antiepileptic drugs and rapamycin at the same time, and followed up for at least 1 year.To observe the change of seizure frequency before and after treatment with rapamycin.ResultsThe mean reduction rate of seizure frequency in children with tuberous sclerosis complicated with refractory epilepsy was 52.1% 6 months after the addition of rapamycin, and 51.2% 12 months after the addition of rapamycin. The number of seizure-free days could be maintained. The difference before and after the addition of rapamycin was statistically significant (P<0.05).ConclusionThe addition of rapamycin in the treatment of TSC complicated with refractory epilepsy can reduce the frequency of seizure and increase the number of days without seizure, and the adverse reactions are mild/moderate. Rapamycin has certain safety in children with regular follow-up.
摘要:目的:探讨关节镜微创手术对膝关节色素沉着绒毛结节性滑膜炎的诊断和治疗价值。方法:本组12例,男7例,女5例,年龄18～46岁,平均33岁;病史2～60个月,平均16个月;其中左膝8例,右膝4例;初次就诊11例,外院开放手术后复发1例。所有病例术前均行MRI检查,并行关节镜检,滑膜切除,记录该病在关节镜下的表现形式(局灶型或弥漫型),样本全部送病理检查。术后加压包扎、局部冰敷并按计划功能锻炼,术后3～4周行患膝放射治疗。结果:本组12例,其中局灶性病例8例,弥漫性4例,术后病理检查确诊;所有病例获得了3~21个月,平均13个月随访,未见复发;术前Lysholm评分(62.3±2.4)分;国际膝关节评分委员会(IKDC)膝关节功能主观评分(56.4±31)分;术后3月复查Lysholm评分(82.5±3.2)分;IKDC主观评分(85.3±2.5)分。除1例开放手术后复发病例术后3月膝关节屈曲受限(80°)外,其余患者功能良好。结论:关节镜手术创伤小,显露充分,病灶切除彻底,术后功能恢复理想,辅以放射治疗可有效降低复发率,对膝关节色素沉着绒毛结节性滑膜炎具有较高的诊治价值。Abstract: Objective: To evaluate the role of arthroscopy in the diagnosis and treatment in knee joint pigmented villonodular synovitis. Methods: 12 cases of knee joint pigmented villonodular synovitis with the age of 18 to 46 years old were treated with arthroscopical synovectomy with a combined application of postoperative exercise and radiotherapy. The history of disease was 2 to 60 months, with the mean of 16 months. The clinical data were reviewed when followedup and evaluated by Lysholm score and and IKDC score. Results: 12 patients diagnosed by pathologic examination,including 8 localized and 4 diffused, were followed up for 3 to 21 months(13 months on average)with no relapses at the time of followup. Lysholm score was (62.3±2.4)points preoperatively, but (82.5±3.2) points 3 months later.The International Knee Documentation Committee (IKDC) score was (56.4±3.1) and (85.3±2.5) respectively before surgery and 3 months later. All patient remained good functions of knee joints except one who relapsed after open operation. Conclusion:In case of pigmented villonodular synovitis of the knee joint, arthroscopical synovectomy combined with postoperative radiotherapy and physical exercise is an effective treatment with less invasion and better function than open operation.
ObjectiveTo analyze and summarize the clinical and video EEG (VEEG) characteristics of tuberous sclerosis (TSC) with epilepsy.MethodsClinical data of 30 children with TSC who met the revised diagnostic criteria of TSC in 2012 from Jan. 2016 to May 2019 in Zhengzhou Children’s Hospital were collected, including 29 children with epileptic seizures. The characteristics of skin lesions, imaging, seizures and long-term VEEG were analyzed retrospectively.ResultsThe mean age was (2.88 ± 2.64), 12 males and 18 females, 1 case of lumbar acid as the first symptom, 29 cases with epilepsy as the first symptom, the incidence of epilepsy is high, and the onset age is less than 1 year old; TSC can cause different degrees of cognitive impact; depigmentation or milk coffee spots are the most common skin changes in young children; TSC with infantile spasm has a high incidence; children younger than 10 years old may have lesions of other organs except nervous system lesions. However, the incidence of other organ lesions was relatively low. Most of TSC children with epilepsy were accompanied by abnormal EEG discharge.ConclusionThe clinical characteristics of TSC with epileptic seizures are various, and early diagnosis is of great significance.