目的 探讨胃嗜酸性肉芽肿的诊断、误诊原因和治疗方法。方法 对14例胃嗜酸性肉芽肿的临床资料进行回顾性分析。结果 全部病例均有上腹疼痛和返酸史； 伴溃疡形成11例，穿孔4例，上消化道出血3例； 术前行胃镜检查2例，X线钡餐透视检查6例，无1例获确诊； 其余病例亦全部误诊为胃溃疡或癌肿。结论 胃镜多部位取材，特别是在溃疡与周边粘膜移行处，采取挖掘式取材，能减少误诊率； 胃大部切除术是主要的治疗方法。
Objective To explore the mechanism of full-thickness burn wound healing with autoskin grafting in fault hypodermis wound of granulation excision and to evaluate its effect.Methods By the techniques of clinical observation, histopathology, immunohistochemistry,TEM and FCM,we observed changes of the activity andstructure of grafted skin and the granulation tissue,collagnous fiber,microvessels,the ultramicrostructure of fibroblasts and the expression of basic fibroblast growth factor(bFGF) in the base of autoskin grafting in fault hypodermis wound in burned adult minipigs(Group A), and compared with traditional method of autoskingrafting on the basilar fibrous tissue wound of scraped partly granulation being(Group B) and control group (Group C, without treatment except de-fur).Results The grafted skin survived after 3 days of operation, and it had less injury and higher proliferative index(PI) in group A than in group B. The hyperplasiaof granulation tissue and vascular endothelial and the expression of bFGF were more evident in group A. After 5 days, the proliferation of endothelial cells and granulation and the protein synthesis of fibroblasts were more active in groupA, and at this moment, fresh collagen appeared and proliferated more actively in group B. After 7-14 days, epidermic structure and dermic microvascular density became normal gradually, the granulation on grafting base matured and transformed into fibrous connective tissue in group A. The same change deferred about 2 days in group B. After 21 days, the above pathologic change in group A was less than that in group B. After 3060 days of operation, Group A achieved much less contraction and transfiguration than Group B, and the grafted skin was tender and movable. Conclusion Autoskin grafting in fault hypodermis wound of granulation excision has a better effect than traditional operation.
ObjectiveTo investigate clinical value of MRI examination in diagnosis of xanthogranulomatous cholecystitis (XGC), and to analyze pathologic correlation of various imaging findings. MethodsMRI imaging data of 7 patients with XGC proved by surgery and pathology who underwent entire MRI sequences examination in Sichuan Provincial People's Hospital from Jan. 2013 to Dec. 2015, were analyzed retrospectively. The thickness and contrast enhancement of gallbladder wall, gallbladder wall nodules, completeness of gallbladder mucosa lines, gallbladder stones, and the changes around the gallbladder were focused in every patient. ResultsIn 7 patients with XGC: gallbladder wall thickening occurred in all patients, in which 2 patients were local thickening, 5 patients were diffuse thickening; ‘hypodense band sign' was found by enhance scan in 4 patients; the multiple intramural nodules were presented in 5 patients, which were low signal intensity on T1WI image and high signal intensity on T2WI image; the mucosal lines were continuous in 6 patients and discontinuous in 1 patient; 6 patients combined with cholecystolithiasis. The fat layer around the gallbladder was found fuzz in 7 patients, liver and gallbladder boundaries were not clear in 7 patients; temporal enhancement of arterial phase in liver parenchyma was observed in all patients, and 1 patient combined with liver abscess. Hilar bile duct narrowed and intra-hepatic bile duct dilated in 2 patients, intra-hepatic and extra-hepatic bile duct slightly dilated in 2 patients (lower part of the choledochus stone was found in 1 patient), liver cyst was observed in 3 patients, single or double kidney cyst was observed in 4 patients; all patients were not found intraperitoneal or retroperitoneal swelling lymph nodes. ConclusionMRI examination can accurately describe various imaging features of XGC, so MRI has important value in diagnosis of XGC.
ObjectiveTo construct a prediction model for the postoperative recurrence risk of granulomatous lobular mastitis (GM) based on multiple systemic inflammatory indicators and clinicopathologic characteristics, with the aim of guiding clinical treatment. MethodsThe GM patients who underwent lesion resection at Sichuan Provincial Hospital for Women and Children from January 2017 to March 2024 were retrospectively collected. The univariate and multivariate logistic regression analyses were used to screen the risk factors for recurrence after GM lesion resection, and a nomogram prediction model was constructed based on the risk factors. The test level was set at α=0.05. ResultsA total of 533 patients with GM were included in this study, of whom 118 cases (22.1%) developed postoperative recurrence. The results of multivariate analysis showed that the not taking oral bromocriptine, having microabscess formation in postoperative pathological examination, systemic immune inflammation index (SII) >789.0×109/L, and immunoglobulin E (IgE) >64.4 U/mL were the independent risk factors for recurrence after GM lesion resection. Based on the risk factors, the nomogram predicting recurrence risk was constructed. The area under the receiver operating characteristic curve (95%CI) was 0.913 (0.895, 0.932), and its sensitivity and specificity were 90.5% and 88.9%, respectively. The calibration curve showed that the probability of recurrence after GM lesion resection predicted by using the nomogram was highly consistent with the actual recurrence probability. The decision curve analysis showed that the nomogram had a good clinical net benefit. ConclusionsThe findings of this study suggest that close postoperative monitoring for recurrence is warranted in patients who did not receive oral bromocriptine treatment, presented with microabscess formation on pathological examination, and exhibited elevated SII and IgE level. The postoperative GM recurrence prediction nomogram model constructed based on risk factors demonstrates a good predictive performance, providing a valuable reference for early treatment and management strategies of GM.