Objective To investigate the protective effects of antitumor necrosis factor-α antibody （TNF-αAb） on lung injury after cardiopulmonary bypass （CPB） and their mechanisms. Methods Forty healthy New Zealand white rabbits，weighting 2.0-2.5 kg，male or female，were randomly divided into 4 groups with 10 rabbits in each group. In groupⅠ，the rabbits received CPB and pulmonary arterial perfusion. In group Ⅱ，the rabbits received CPB and pulmonary arterial perfusion with TNF-αAb. In group Ⅲ，the rabbits received CPB only. In group Ⅳ，the rabbits only received sham surgery. Neutrophils count，TNF-α and malondialdehyde （MDA） concentrations of the blood samples from the left and right atrium as well as oxygenation index were examined before and after CPB in the 4 groups. Pathological and ultrastructural changes of the lung tissues were observed under light and electron microscopes. Lung water content，TNF-α mRNA and apoptoticindex of the lung tissues were measured at different time points. Results Compared with group Ⅳ，after CPB，the rabbitsin group Ⅰ to group Ⅲ showed significantly higher blood levels of neutrophils count，TNF-α and MDA（P＜0.05），higherTNF-α mRNA expression，apoptosis index and water content of the lung tissues （P＜0.05），and significantly lower oxyg-enation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with group Ⅱ，after CPB，the rabbits in groups Ⅰ and Ⅲ had significantly higher blood concentrations of TNF-α （5 minutes after aortic declamping，220.43±16.44 pg/ml vs.185.27±11.78 pg/ml，P＜0.05；249.99±14.09 pg/ml vs.185.27±11.78 pg/ml，P＜0.05），significantly higher apoptosis index （at the time of CPB termination，60.7‰±13.09‰ vs. 37.9‰±7.78‰，P＜0.05；59.6‰±7.74‰ vs. 37.9‰±7.78‰，P＜0.05），significantly higher blood levels of neutrophils count and MDA （P＜0.05），significantly higher TNF-α mRNA expression and water content of the lung tissues （P＜0.05），and significantly loweroxygenation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with groupⅠ，rabbits in group Ⅲ had significantly higher above parameters （P＜0.05） but lower oxygenation index （P＜0.05） only at 30 minutes after the start of CPB. Conclusion Pulmonary artery perfusion with TNF-αAb can significantly attenuate inflammatory lung injury and apoptosis of the lung tissues during CPB.
目的结合近期收治的1例肝脏血管周上皮样细胞肿瘤（perivascular epitheliod cell tumor，PEComa）的病例特点，总结该疾病的诊治体会。 方法回顾分析2013年9月笔者所在医院成功收治的1例肝脏原发PEComa的诊治过程，并结合既往文献报道，总结和复习该疾病的临床特点以及处理方法。 结果肝脏PEComa较为罕见，起病隐匿，症状缺乏特异性，临床诊断困难，多依赖病理学检查证实，手术切除是有效的治疗手段。 结论提高本病影像学特征的认识有助于术前肿瘤性质的判断，本病预后较好，但术后仍需要长期密切观察随访。
【摘要】目的 探讨低磁场MRI诊断胰腺癌的价值。方法 回顾性分析我院78例经手术和病理证实的胰腺癌的MRI表现。结果 肿瘤的低磁场MRI主要表现为胰腺出现局部软组织肿块或全部肿大，轮廓、信号异常，T1加权像呈等或低信号，信号不均匀，T2加权像信号不均匀增高； 肝内外胆管、胰管扩张，邻近组织及器官受累。结论 低磁场MRI能较好地显示胰腺癌的大小、形态和继发的胆、胰管梗阻、扩张以及肿瘤转移、侵袭范围，有利于肿瘤的诊断。
Objective To probe the clinical character,the histopathological classification and misdiagnoses of intraocular tumors. Methods The clinical and pathological data of 359 patients with intraocular tumor diagnosed clinically between 1980～2000 were retrospectively analyzed. Results There were 300 cases of malignant tumor and 23 cases of benign tumor respectively. Non-oncologic malady and benign tumor misdiagnosed as tumor or malignant tumor were 40 cases. The two leading malignant tumors were retinoblastoma and melanoma. Conclusion The clinical and pathological analysis of intraocular tumor is beneficial to the correct clinical diagnosis and treatment. (Chin J Ocul Fundus Dis,2002,18:28-30)
Objective To study the surgical treatment of tracheal and main bronchial tumors. Methods We retrospectively analyzed the clinical data of 30 patients with tracheal and main bronchial tumors treated in Shengjing Hospital of China Medical University from January 2000 to December 2015. There were 12 males and 18 females with the age ranging from 22 to 80 years. Results Ten patients were treated with enucleation, 12 patients tracheal tumor resection and end-to-end anastomosis, 1 patient window resection, 1 patient wedge resection, 5 patients tumor resection and tracheal reconstruction by using pulmonary tissue flap with alloy stent and 1 patient left pneumonectomy. One patient died of sudden massive hemoptysis 26 d after operation. Intraoperative complications were found in 2 patients. Others had a good recovery after operation. Patients were followed up for 11 months to 14 years. Eight patients were followed up less than 5 years postoperatively, one patient died of sudden massive hemoptysis 14 months after operation, while others survived; 21 patients were followed up more than 5 years and 5 patients were lost to follow-up. Conclusion Surgical resection is recommended for tracheal and main bronchial tumors. Patients with small benign tumor may choose local tracheal resection; tracheal segmental resection and end-to-end anastomosis is the most common surgical treatment. Patients with more than half of the whole length of tracheal defects or in the risk of anastomotic ischemic necrosis may be suggested to receive tracheal reconstruction.
Objective To evaluate the application value of scanning laser angiography with a wide-field contact lens system in the diagnosis of choroidal melanoma. Methods Twenty-four patients with choroidal melanoma were randomly divided into two groups, who underwent fundus fluorescein angiography and indocyanine green angiography scanning with the wide-field contact and non-contact lens system respectively in order to acquire the 150deg;wide-field and 30deg;view image data. The quality of the images was comprehensively evaluated. Results Satisfying images were acquired from all of the 24 patients. Widefield contact lens system indicated the accurate adjacent relation between the lesion position and the other dissection mechanisms, and also provided the general information about the size of the tumor and the perfusion of fluorescien or indocyanine green in the blood vessels. At the same time, it enlarged the view scope 3-5 times, which make for the screening of the peripheral lesions. Conclusions Scanning laser angiography with a wide-field contact lens system has important application value in the diagnosis of choroidal melanoma. (Chin J Ocul Fundus Dis, 2006, 22: 166-169)
T ree cases of sarcomas of theJ we femur were treated by region-a?ir? ation with overdosage of me-chlorethamine for 3 weeks and there-after a high amputation was done,and the distal leg was replantedwith the length that the anklewould act as a knee joint and thefoot pointing backword. Follow-upfor 1 -5 years discovered no me-tastasie of the tumor and the artifi-cial limb showed a better function.
目的 探讨十二指肠良性肿瘤的诊断与治疗。方法 对1992~1998年间收治的10例患者的临床资料行回顾性总结分析。 结果术前经纤维十二指肠镜确诊7例 ，上消化道X线钡餐确诊3例。肿瘤位于十二指肠降部7例，球部3例。其中6例行手术治疗，4例因心肺脑等严重合并症行保守治疗。手术为十二指肠肿瘤局部切除连同周围肠壁组织部分切除。术后病理报告2例为平滑肌瘤，2例为布鲁氏纳氏腺瘤，2例为间质瘤。结论 十二指肠良性肿瘤可引发严重并发症，如出血、腹痛、肠梗阻、穿孔等，并约有15%的病例可发生恶变。一经诊断，应及早手术治疗，手术一般宜行局部切除。
Objective To explore the effect of facial artery musculo-mucosal (FAMM) flap to reconstruct tongue and floor of mouth defects. Methods Between January 2011 and January 2016, 24 cases of tongue and floor of mouth defects were repaired with FAMM flap after tumor resection. There were 16 males and 8 females, aged from 38 to 70 years with an average of 55 years. The disease duration was from 1 week to 6 months with an average of 4 months. The defect located at the floor of mouth in 4 cases, at the tongue in 15 cases, and both tongue and floor of mouth in 5 cases. There were 2 cases of carcinoma at the floor of mouth, 2 cases of adenoid cystic carcinoma at the floor of mouth, 14 cases of carcinoma at the tongue, 1 case of adenoid cystic carcinoma at the tongue, and 5 cases of carcinoma at the tongue and floor of mouth. The size of defect ranged from 4 cm×3 cm to 8 cm×7 cm. Three ipsilateral and 21 contralateral FAMM flaps were harvested (5 cases were repaired with FAMM flap and submental muscle island flap due to the large defect area). The size of FAMM flap ranged from 5 cm×4 cm to 5 cm×5 cm, the size of submental muscle island flap ranged from 4 cm×3 cm to 5 cm×4 cm. Results All flaps survived after operation, without local necrosis. Wound dehiscence at donor site occurred in 5 cases, and healed after cleaning; primary healing was obtained in the other 19 cases. All the patients were followed up 8 months to 5 years with an average of 2 years and 4 months. No obvious facial deformity or fistula of the floor of mouth occurred after operation. Injury of the submandibular branch of the facial nerve was observed in 16 patients, who returned to normal at 3 months. All 24 patients had limitation of mouth opening after operation, which disappeared after 12 months. The functions of speech, chewing, and swallowing were normal. Conclusion FAMM flap has many advantages of simple operation, good repair, high flap survival rate, and less injury at donor site for repairing tongue and floor of mouth defects.
目的 探讨结肠癌和直肠癌并发肠穿孔的外科诊治方法。方法 分析13例结直肠癌并发肠穿孔患者的临床资料。结果 13例患者中4例行肿瘤所在肠段一期切除吻合术； 4例行一期病灶切除吻合术，近端肠段行外置双管造瘘术； 2例切除肿瘤所在肠段，近端行端式结肠造瘘术，远端行封闭（Hartmann）术； 3例行单纯肠造瘘术。术后并发症发生率为46.15%（6/13），手术死亡率为15.38%（2/13）。结论 重视对结直肠癌并发肠穿孔的认识及选择合适的手术方式是减少并发症、提高疗效的重要措施。