Objective To summarize the clinical features of lymphangioleiomyomatosis ( LAM) in Chinese population. Methods The first case of LAM in China was reported in 1981. All cases of LAM reported in Chinese literature from January 1981 to December 2009 were reviewed. The cases for analysis were included with a diagnosis of LAM confirmed or probable according to the guidelines of European Respiratory Society, and with individual clinical data available. Results A total of 111 cases of LAM werepooled for analysis. All cases were female. The most frequent onset symptomof LAMwas dyspnea ( 51. 4% ) .The main clinical manifestations included dyspnea ( 93. 4% ) , pneumothorax ( 48. 6% ) , cough ( 45. 7% ) ,hemoptysis ( 35. 1% ) , and chylothorax ( 33. 3% ) . 11 cases were associated with tuberous sclerosis complex.An obstructive with or without restrictive abnormality in pulmonary function testing was observed in 60 /67 cases. Diffusion impairment was also common ( 45 /46) . Of the 109 patients, computerized tomography of chest showed thin-walled air-filled cysts throughout both lungs in 104 cases, multiple bullae in 3 cases, andhoneycomb changes in 2 cases. 102 cases were diagnosed based on pathological findings. Misdiagnosis was found in 44 cases, the median time of misdiagnosis was 24 months. Conclusion Awareness of LAMshould be raised when an adult female who presents with an unexplained dyspnea, especially combined with repeatedpneumothorax or chylothorax.
目的:探讨MSCT对结肠癌诊断价值。方法:收集我院手术病理证实且经MSCT检查的结肠癌患者,对其CT表现进行分析,并与纤维结肠镜(FC),钡灌肠对比研究。结果:所有收集的结肠癌患者,MSCT均能多角度,多方法显示病变。结论: MSCT检查对结肠癌具有较高的诊断价值且对临床治疗有重大指导意义。
Objective To elucidate the clinical features and treatment of parapneumonic effusions ( PPE) . Methods Ninety-seven patients were analyzed retrospectively in Guangzhou First Municipal People’s Hospital fromJanuary 2004 to July 2008. The data of 54 patients with complicated parapneumonic effusion ( CPPE) and 9 cases with empyema were compared with 49 patients with tuberculosis pleural effusions. Results Of 97 cases, 34 patients with uncomplicated parapneumonic effusion ( UPPE) were treated with antibiotics only, whose hospitalization time was ( 14. 8 ±7. 6) days, and 27 cases were cured ( 79. 4% ) . Of 54 CPPE patients, 42 were treated with antibiotics and pleural space drainage with central venous catheter, whose hospitalization time was ( 21. 7 ±13. 0) days, and 32 were cured ( 76. 2% ) . Another12 CPPE patients were treated with interapleural urokinase and drainage from the chest tube, whose hospitalization time was ( 22. 5 ±9. 3) days, and 8 were cured ( 66. 7% ) . Nine cases with empyema were rinsed the pleural with metronidazole solution, whose hospitalization time was ( 25. 7 ±17. 4) days, and 8 were cured( 89. 0% ) . Compared with the tuberculous pleurisy patients, most CPPE and empyema occurred in middle and old aged patients with an average age of ( 63. 3 ±19. 3) years. Polykaryocyte and lactate dehydrogenase increased significantly. Adenosine deaminase ( ADA) was lt; 45 U/L in most UPPE and empyema patients, but was gt; 45 U/L in 7 cases ( 11% ) . Conclusions UPPE is simple and preferably treated with antibiotics alone. While CPPE and empyema should be drainaged as early as possible, and the low-dose urokinase may be helpful. The level of ADA can not absolutely distinguish parapneumonic effusion from tuberculous pleural effusion.
目的 探讨胰腺囊性肿瘤的诊断及外科治疗方法。方法 对我院2003年4月至2012年4月期间收治的19例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果 本组19例患者中浆液性囊腺瘤8例，黏液性囊腺瘤5例，导管内乳头状黏液瘤4例，实性假乳头状瘤1例，囊腺癌1例。行B超或CT发现胰腺占位病变。位于胰头部5例，胰体部8例，胰尾部6例。行肿瘤摘除术4例，保留脾脏的胰体尾切除术5例，胰体尾＋脾脏切除手术3例，胰十二指肠切除术6例，1例囊腺癌患者因肝脏转移伴腹腔广泛转移、侵犯大血管而肿瘤不能切除仅行胃空肠、胆肠吻合。术后发生胰瘘2例，腹腔感染1例，经保守治疗后康复出院。无围手术期死亡病例。19例患者均进行了随访，随访时间6～80个月，平均45.2个月。1例囊腺癌合并肝脏转移患者于术后7个月死亡，其余良性肿瘤患者均未见复发，最长已存活5年。结论 胰腺囊性肿瘤主要靠影像学检查发现，手术切除是理想的治疗方法，选择合适的术式有助于避免术后并发症的发生和改善预后。
目的:探讨鼻咽癌延误诊断的原因。从而提高鼻咽癌患者的早期诊断率,改善治疗效果。方法: 回顾性分析324例在我科接诊前因各种因素而延误诊断的鼻咽癌患者首发症状、首诊误诊科室、误诊疾病。结果: 本组病例首发症状分别为颈部包块138例(42.5%)、鼻部症状148例(45.6%)、耳部症状66例(20.3%)、头痛46例(14.2%)、其他17例(5.2%),有两种首发症状的病例为91例。首诊误诊的疾病有颈部淋巴结炎、慢性鼻鼻窦炎、鼻出血、分泌性中耳炎、脑动脉硬化等27种疾病。涉及普外科、耳鼻咽喉科、神经内科、骨科、呼吸内科、口腔科、烧伤科、眼科、中医科等9个科室。结论: 加强鼻咽癌知识普及,完善继续医学教育及住院医师培训,积极寻找鼻咽癌的早期诊断方法能减少鼻咽癌的延误诊断。
胰腺癌早期症状隐匿，缺乏特异性，易被忽视，患者就诊时多为进展期，手术切除率特别是根治性手术切除率较低，远期疗效不佳。近20年来，尽管新的影像诊断技术及综合治疗手段不断问世，给许多恶性肿瘤的治疗开创了崭新的局面，但却未从根本上改变胰腺癌诊治的窘境。胰腺癌总体疗效较差，但早期病例根治术后仍可使其生存率明显延长。据美国对1989～1995年1340家医院的100313例胰腺癌的统计，Ⅰ期胰腺癌的5年生存率为32.8%。日本的全国统计资料显示，Ⅰ期胰腺导管癌的术后5年生存率达61%。可见，提高胰腺癌远期疗效的关键仍在于早期诊断。目前，影像学检查是胰腺癌最常用的检查手段，对影像学检查呈现出一些细微变化而难以定性的患者，下述方法可成为早期诊断的佐证。
ObjectiveTo observe and assess the clinical value of electrophysiology of ocular surface in the diagnosis and treatment of blepharospasm in Meige syndrome (MS). MethodsA single-center, cross-sectional study. A total of 413 patients diagnosed with MS and undergoing surgical treatment at the Henan Provincial Meige Syndrome Diagnosis and Treatment Center of the Henan Provincial Third People′s Hospital from May 2022 to December 2023 were included as the MS group. A total of 110 age- and gender-matched spouses of patients and community volunteers were selected as the control group. The bioelectricity detection program of the electrooculogram was used; the frequency bandwidth was set at 0.3 to 300.0 Hz. Surface electrodes were employed to record the surface electrophysiological manifestations of the corrugator supercilii muscle and the lower orbicularis oculi muscle, as well as the conditions and temporal characteristics of spasm waves. Based on the amplitude and waveform of the electrophysiology of ocular surface signals, it can be classified into 0-4 grades. The blepharospasm was divided into conditionally induced type, spastic type, reverse spastic type, and oro-ocular elicited type. All patients were treated with neural circuit occlusion, and the postoperative follow-up time was 4.1 (0.5-19.0) months. The distribution of different grades of electrophysiology of ocular surface in the MS and control group at baseline were observed, as well as within the MS group at the last follow-up visit. Additionally, the blepharospasm grades in the MS group were also assessed. The comparison of the distribution of the number of eyes with different grades of electrophysiology of ocular surface between groups was conducted using the Mann-Whitney U test. ResultsAt baseline, in the MS group, the number of cases with corrugator supercilii muscle amplitudes and morphologies graded from 0 to 4 were as follows: 15 (3.60%, 15/413) for grade 0, 95 (23.00%, 95/413) for grade 1, 142 (34.38%, 142/413) for grade 2, 127 (30.75%, 127/413) for grade 3, and 34 (8.24%, 34/413) for grade 4. In the control group, the corresponding numbers of individuals were 82 (74.54%, 82/110) for grade 0, 24 (21.82%, 24/110) for grade 1, 4 (3.64%, 4/110) for grade 2, 0 (0.00%, 0/110) for grade 3, and 0 (0.00%, 0/110) for grade 4. For the orbicularis oculi muscle, there were 35 cases (8.47%) in grade 0, 124 cases (30.03%) in grade 1, 150 cases (36.32%) in grade 2, 90 cases (21.79%) in grade 3, and 14 cases (3.39%) in grade 4 in the MS group. In the control group, there were 86 cases (78.18%) in grade 0, 24 cases (21.82%) in grade 1, and 0 cases in grades 2, 3, and 4. There were statistically significant differences in the distribution of the number of eyes with different electrophysiology of ocular surface grading of the corrugator supercilii muscle and the orbicularis oculi muscle between the MS and control group (Z=−14.51, −13.86; P＜0.001). Meanwhile, there were statistically significant differences in the distribution of the number of eyes with different electrophysiology of ocular surface grading of the corrugator supercilii muscle and the orbicularis oculi muscle between preoperation and at the last follow-up in the MS group (Z=−16.52, −17.36; P＜0.001). In the MS group, there were 61 (14.77%, 61/413), 306 (74.09%, 306/413), 27 (6.54%, 27/413) and 19 (4.60%, 19/413) cases of blepharospasm conditionally induced type, spasm type, reverse spasm type and oro-ocular elicited type, respectively. ConclusionThe electrophysiology of the ocular surface can objectively reflect the activity of periocular neuromuscular.