Objective To analyze the clinical characteristics of nonfunctioning pheochromocytoma, and to evaluate the efficacy of 131I-metaiodobenzylguanidine (MIBG) scan in the diagnosis and perioperative treatment of nonfunctio...Objective To analyze the clinical characteristics of nonfunctioning pheochromocytoma, and to evaluate the efficacy of 131I-metaiodobenzylguanidine (MIBG) scan in the diagnosis and perioperative treatment of nonfunctioning pheochromocy- toma. Methods The clinical data of 14 patients with nonfunctioning pheochromocytoma were analyzed retrospectively. Plasma free corticoid, renin, aldosterone, and urine catecholamines levels were estimated. B-mode ultrasonography, computed tomo- graphy scan, thoracic X-ray and 131I-MIBG were used. Results All patients with nonfunctioning pheochromocytoma had no hypertension and the tumors were found inciden- tally. The 24 hours urine catecholamines levels in 80% (8/10) patients were normal. The positive rate of 131I-MIBG was 80% (8/10) and the specificity was 100%. All patients underwent surgical operation of tumor resection. No preoperative volume expansion was given to all patients. All tumors were resected completely, and no death accident happened. There was no recurrence and metastasis after operation by long-term follow-up. Conclusion 131I-MIBG scan is the first choice technique for the diagnosis of nonfunctioning pheochromocytoma. Blood volume expansion is unnecessary before resection of pheochromocytoma.no recurrence and metastasis})展开更多
Melanoma accounts for 1-3 per cent of all malignant tumors. Except cutaneous, other less common melanomas include, among others, those in the GI tract. However, their primary or secondary nature is often difficult to ...Melanoma accounts for 1-3 per cent of all malignant tumors. Except cutaneous, other less common melanomas include, among others, those in the GI tract. However, their primary or secondary nature is often difficult to establish. Referring to the stomach, scattered cases of primary melanomas have been reported in the literature. We report a case of a man with an ulcerated submucosal mass at the antrum of the stomach, manifested with dull upper abdominal pain, nausea, vomiting, fatigue and anemia. This lesion was histologically proved to be melanoma. A detailed clinical and laboratory investigation revealed no primary site elsewhere. To our knowledge, very few cases of primary gastric melanoma have been reported. Our case is the fourth ever published and the first located at the antrum of the stomach. The debate upon the primitive nature of such lesions still persists. Thus, specific diagnostic criteria have been proposed.展开更多
The definition of large stones is not clear ranging from 10 mm to 15 mm and does not include the lower common bile duct (CBD) diameter. Three hundred and four patients who underwent endoscopic retrograde cholangiopanc...The definition of large stones is not clear ranging from 10 mm to 15 mm and does not include the lower common bile duct (CBD) diameter. Three hundred and four patients who underwent endoscopic retrograde cholangiopancreatography and stone extraction were retrospectively analyzed over a 1-year period. Sixteen patients were different from others in that 10 patients with large stones had stone extraction with a wire basket or a balloon catheter and 6 patients with small stones had stone extraction with mechanical lithotripsy. The defi nition of large stones should include diameter of the lower CBD and any stone in lower CBD with its diameter greater than 2 mm.展开更多
AIM: To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fi stulae in adults. METHODS: Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treat...AIM: To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fi stulae in adults. METHODS: Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treated in our hospital between May 1990 and August 2010 were reviewed. Its clinical presentations, diagnostic methods, anatomic type, treatment, and follow-up were recorded. RESULTS: Of the chief clinical presentations, nonspecific cough and sputum were found in 10 (90.9%), recurrent bouts of cough after drinking liquid food in 6 (54.6%), hemoptysis in 6 (54.6%), low fever in 4 (36.4%), and chest pain in 3 (27.3%) of the 11 cases, respectively. The duration of symptoms before diagnosis ranged 5-36.5 years. The diagnosis of congenital bronchoesophageal fistulae was established in 9 patients by barium esophagography, in 1 patient by esophagoscopy and in 1 patient by bronchoscopy, respectively. The congenital bronchoesophageal fistulae communicated with a segmental bronchus, a main bronchus, and an intermediate bronchus in 8, 2 and 1 patients, respectively.The treatment of congenital bronchoesophageal fistulae involved excision of the fistula in 10 patients or division and suturing in 1 patient. The associated lung lesion was removed in all patients. No long-term sequelae were found during the postoperative follow-up except in 1 patient with bronchial fistula who accepted reoperation before recovery. CONCLUSION: Congenital bronchoesophageal fistula is rare in adults. Its most useful diagnostic method is esophagography. It must be treated surgically as soon as the diagnosis is established.展开更多
Objective： To study the diagnostic and therapeutic features of prolactinoma. Methods： 124 patients with prolactinoma were studied in clinical manifestation, pathologic, endocrinological, radiographic and therapeutic...Objective： To study the diagnostic and therapeutic features of prolactinoma. Methods： 124 patients with prolactinoma were studied in clinical manifestation, pathologic, endocrinological, radiographic and therapeutic features. Results： The average age of the male patients was 41.6 years, 32.3 years of females. The major clinical manifestation in males were sexual and visual disfunction. In females, disfunction of menstruates and galactorrhea. Average serum prolactin was 1875.22 in males, 376.6 ng/mL in females. Average diameter of the tumors was 38.05 mm in males, and 83.3% of the tumors were invasive, in females were 15.25 mm and 49%. After surgery, the average serum prolactin decreased to 385.84 ng/mL （P〈 0.05）, 13 of 15 patients improved in sexual function, 82.6% patients improved in eyesight and visual field. In females prolactin decreased to 23.93 ng/mL （P 〈 0.05）, and 81.25% infertility with microprolactinoma got pregnancy, higher than controls of drug therapy （P 〈 0.05）. Conclusion： In males, the tumors were usually larger and more invasive, and serum prolactin levels were higher. The patients were elder. But in females, much younger than males, most of the tumors were microadenoma, and after operation the prolactin usually decrease to normal level and more chance of pregnancy. Results of a single therapy were with less satisfaction, we advocate integrated therapy around operation.展开更多
Objective To evaluate the clinical value of alarm symptoms in diagnosis of lower gastrointestinal diseases. Methods Data of consecutive autochthonous patients referred to the endoscopy center of Renji Hospital during ...Objective To evaluate the clinical value of alarm symptoms in diagnosis of lower gastrointestinal diseases. Methods Data of consecutive autochthonous patients referred to the endoscopy center of Renji Hospital during the period of Oct. 2002 to Dec. 2003 were retrospectively analyzed. The prevalence of alarm symptoms in Shanghai patients with colorectal malignancies or other organic or functional lower gastrointestinal diseases was investigated. Results 83 （4. 9% ） cases of colorectal malignancies were found in 1681 patients referred to the center for colonoscopy because of lower gastrointestinal symptoms. All these malignancies were verified to be in the progressive stage. The prevalence of alarm symptoms was 81.9% （68/83）. Hematochezia （ OR 4. 1, 95% CI 3.3 -5.2, P 〈0. 001）, melena （0R6.4, 95%CI3. 7-11. 0, P 〈0. 001） and anemia （OR 9.6, 95%C13. 7 - 25. 0, P 〈 0. 001 ） were the most common and specific alarm symptoms. All the patients without alarm symptoms were above the age of 40 years. 264 （15. 7% ） cases of organic colorectal diseases other than malignancies and 1334 （ 79. 4% ） cases with no causal pathology identified were found in 1681 patients, and the prevalence of alarm symptoms in these two groups was 48. 5% （128/264） and 14. 8% （197/1334）, respectively. Conclusion Alarm symptoms including hemotochezia, melena, and anemia were useful in distinguishing organic from functional colorectal diseases in patients over 40 years old at the onset of symptoms. Furthermore, hematochezia, melena, anemia, severe weight loss, and abdominal mass were helpful in differentiating malignant from non-malignant colorectal diseases. Colonoscopy should be recommended for patients regardless of age with these alarm symptoms, and so do patients above the age of 40 years with no alarm symptoms before the diagnosis of functional diseases are made.展开更多
Objective To evaluate prospectively the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography (FDG-PET) in the detection of recurrence, second primary cancers, and distant metastases in head and neck s...Objective To evaluate prospectively the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography (FDG-PET) in the detection of recurrence, second primary cancers, and distant metastases in head and neck squamous cell carcinoma (HNSCC) 6 months after treatment. Methods A total of 41 patients without any clinical element for recurrence, second primary cancer, or distant metastases received a whole-body FDG-PET as a routine surveillance tool 6 months after initial combined curative therapy for HNSCC. Results There were 35 negative PET results and 6 positive. One patient with abnormal FDG-PET did not have recurrent HNSCC (false positive). Five had true positive results: proven recurrence in 2 patients, second primary cancer in 2, and distant metastasis in 1. The sensitivity and specificity of FDG-PET for the diagnosis of HNSCC recurrence, second tumor, and distant metastases were 100% (5/5) and 97.2% (35/36), respectively. The positive predictive value was 83.3% (5/6). The negative predictive value was 100% (35/35). The overall accuracy was 97.6% (40/41). FDG-PET had a therapeutic impact in 5 of 41 patients (12.2%). There was no impact of FDG-PET on management in other 36 patients. Conclusion FDG-PET is useful as primary method for detecting nodal recurrence and distant metastases in HNSCC as well as second cancer in subclinical patients as it had a high effectiveness. But systematic FDG-PET performed at 6 months in patients without any clinical suspicion of local recurrence was scarcely useful.展开更多
To evaluate current diagnosis and therapeutic effect and outcome of diffuse axonal injury （DAI） in 169 patients. Methods ： The data of 169 DAI patients treated in the Second, Sixth, Eighth and Ninth Hospitals of S...To evaluate current diagnosis and therapeutic effect and outcome of diffuse axonal injury （DAI） in 169 patients. Methods ： The data of 169 DAI patients treated in the Second, Sixth, Eighth and Ninth Hospitals of Shenzhen and Shekou Hospital from January 2001 to January 2005 were collected. The imaging features, classification, GCS （Glasgow coma scale）, treatment and outcome of the 169 patients were retrospecti.vely analyzed. Results ： The simpler the imaging features, the closer the focus of DAI to the periphery of hemisphere and the higher the GCS score, the better the prognoses of DAI patients will be. Conclusions： The prognoses of DAI patients are closely related to the imaging features and classification, GCS and clinical treatment.展开更多
文摘Objective To analyze the clinical characteristics of nonfunctioning pheochromocytoma, and to evaluate the efficacy of 131I-metaiodobenzylguanidine (MIBG) scan in the diagnosis and perioperative treatment of nonfunctioning pheochromocy- toma. Methods The clinical data of 14 patients with nonfunctioning pheochromocytoma were analyzed retrospectively. Plasma free corticoid, renin, aldosterone, and urine catecholamines levels were estimated. B-mode ultrasonography, computed tomo- graphy scan, thoracic X-ray and 131I-MIBG were used. Results All patients with nonfunctioning pheochromocytoma had no hypertension and the tumors were found inciden- tally. The 24 hours urine catecholamines levels in 80% (8/10) patients were normal. The positive rate of 131I-MIBG was 80% (8/10) and the specificity was 100%. All patients underwent surgical operation of tumor resection. No preoperative volume expansion was given to all patients. All tumors were resected completely, and no death accident happened. There was no recurrence and metastasis after operation by long-term follow-up. Conclusion 131I-MIBG scan is the first choice technique for the diagnosis of nonfunctioning pheochromocytoma. Blood volume expansion is unnecessary before resection of pheochromocytoma.no recurrence and metastasis})
文摘Melanoma accounts for 1-3 per cent of all malignant tumors. Except cutaneous, other less common melanomas include, among others, those in the GI tract. However, their primary or secondary nature is often difficult to establish. Referring to the stomach, scattered cases of primary melanomas have been reported in the literature. We report a case of a man with an ulcerated submucosal mass at the antrum of the stomach, manifested with dull upper abdominal pain, nausea, vomiting, fatigue and anemia. This lesion was histologically proved to be melanoma. A detailed clinical and laboratory investigation revealed no primary site elsewhere. To our knowledge, very few cases of primary gastric melanoma have been reported. Our case is the fourth ever published and the first located at the antrum of the stomach. The debate upon the primitive nature of such lesions still persists. Thus, specific diagnostic criteria have been proposed.
文摘The definition of large stones is not clear ranging from 10 mm to 15 mm and does not include the lower common bile duct (CBD) diameter. Three hundred and four patients who underwent endoscopic retrograde cholangiopancreatography and stone extraction were retrospectively analyzed over a 1-year period. Sixteen patients were different from others in that 10 patients with large stones had stone extraction with a wire basket or a balloon catheter and 6 patients with small stones had stone extraction with mechanical lithotripsy. The defi nition of large stones should include diameter of the lower CBD and any stone in lower CBD with its diameter greater than 2 mm.
文摘AIM: To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fi stulae in adults. METHODS: Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treated in our hospital between May 1990 and August 2010 were reviewed. Its clinical presentations, diagnostic methods, anatomic type, treatment, and follow-up were recorded. RESULTS: Of the chief clinical presentations, nonspecific cough and sputum were found in 10 (90.9%), recurrent bouts of cough after drinking liquid food in 6 (54.6%), hemoptysis in 6 (54.6%), low fever in 4 (36.4%), and chest pain in 3 (27.3%) of the 11 cases, respectively. The duration of symptoms before diagnosis ranged 5-36.5 years. The diagnosis of congenital bronchoesophageal fistulae was established in 9 patients by barium esophagography, in 1 patient by esophagoscopy and in 1 patient by bronchoscopy, respectively. The congenital bronchoesophageal fistulae communicated with a segmental bronchus, a main bronchus, and an intermediate bronchus in 8, 2 and 1 patients, respectively.The treatment of congenital bronchoesophageal fistulae involved excision of the fistula in 10 patients or division and suturing in 1 patient. The associated lung lesion was removed in all patients. No long-term sequelae were found during the postoperative follow-up except in 1 patient with bronchial fistula who accepted reoperation before recovery. CONCLUSION: Congenital bronchoesophageal fistula is rare in adults. Its most useful diagnostic method is esophagography. It must be treated surgically as soon as the diagnosis is established.
文摘Objective： To study the diagnostic and therapeutic features of prolactinoma. Methods： 124 patients with prolactinoma were studied in clinical manifestation, pathologic, endocrinological, radiographic and therapeutic features. Results： The average age of the male patients was 41.6 years, 32.3 years of females. The major clinical manifestation in males were sexual and visual disfunction. In females, disfunction of menstruates and galactorrhea. Average serum prolactin was 1875.22 in males, 376.6 ng/mL in females. Average diameter of the tumors was 38.05 mm in males, and 83.3% of the tumors were invasive, in females were 15.25 mm and 49%. After surgery, the average serum prolactin decreased to 385.84 ng/mL （P〈 0.05）, 13 of 15 patients improved in sexual function, 82.6% patients improved in eyesight and visual field. In females prolactin decreased to 23.93 ng/mL （P 〈 0.05）, and 81.25% infertility with microprolactinoma got pregnancy, higher than controls of drug therapy （P 〈 0.05）. Conclusion： In males, the tumors were usually larger and more invasive, and serum prolactin levels were higher. The patients were elder. But in females, much younger than males, most of the tumors were microadenoma, and after operation the prolactin usually decrease to normal level and more chance of pregnancy. Results of a single therapy were with less satisfaction, we advocate integrated therapy around operation.
基金Supported by Shanghai Leading Academic Discipline Project, China (Y0205)
文摘Objective To evaluate the clinical value of alarm symptoms in diagnosis of lower gastrointestinal diseases. Methods Data of consecutive autochthonous patients referred to the endoscopy center of Renji Hospital during the period of Oct. 2002 to Dec. 2003 were retrospectively analyzed. The prevalence of alarm symptoms in Shanghai patients with colorectal malignancies or other organic or functional lower gastrointestinal diseases was investigated. Results 83 （4. 9% ） cases of colorectal malignancies were found in 1681 patients referred to the center for colonoscopy because of lower gastrointestinal symptoms. All these malignancies were verified to be in the progressive stage. The prevalence of alarm symptoms was 81.9% （68/83）. Hematochezia （ OR 4. 1, 95% CI 3.3 -5.2, P 〈0. 001）, melena （0R6.4, 95%CI3. 7-11. 0, P 〈0. 001） and anemia （OR 9.6, 95%C13. 7 - 25. 0, P 〈 0. 001 ） were the most common and specific alarm symptoms. All the patients without alarm symptoms were above the age of 40 years. 264 （15. 7% ） cases of organic colorectal diseases other than malignancies and 1334 （ 79. 4% ） cases with no causal pathology identified were found in 1681 patients, and the prevalence of alarm symptoms in these two groups was 48. 5% （128/264） and 14. 8% （197/1334）, respectively. Conclusion Alarm symptoms including hemotochezia, melena, and anemia were useful in distinguishing organic from functional colorectal diseases in patients over 40 years old at the onset of symptoms. Furthermore, hematochezia, melena, anemia, severe weight loss, and abdominal mass were helpful in differentiating malignant from non-malignant colorectal diseases. Colonoscopy should be recommended for patients regardless of age with these alarm symptoms, and so do patients above the age of 40 years with no alarm symptoms before the diagnosis of functional diseases are made.
文摘Objective To evaluate prospectively the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography (FDG-PET) in the detection of recurrence, second primary cancers, and distant metastases in head and neck squamous cell carcinoma (HNSCC) 6 months after treatment. Methods A total of 41 patients without any clinical element for recurrence, second primary cancer, or distant metastases received a whole-body FDG-PET as a routine surveillance tool 6 months after initial combined curative therapy for HNSCC. Results There were 35 negative PET results and 6 positive. One patient with abnormal FDG-PET did not have recurrent HNSCC (false positive). Five had true positive results: proven recurrence in 2 patients, second primary cancer in 2, and distant metastasis in 1. The sensitivity and specificity of FDG-PET for the diagnosis of HNSCC recurrence, second tumor, and distant metastases were 100% (5/5) and 97.2% (35/36), respectively. The positive predictive value was 83.3% (5/6). The negative predictive value was 100% (35/35). The overall accuracy was 97.6% (40/41). FDG-PET had a therapeutic impact in 5 of 41 patients (12.2%). There was no impact of FDG-PET on management in other 36 patients. Conclusion FDG-PET is useful as primary method for detecting nodal recurrence and distant metastases in HNSCC as well as second cancer in subclinical patients as it had a high effectiveness. But systematic FDG-PET performed at 6 months in patients without any clinical suspicion of local recurrence was scarcely useful.
文摘To evaluate current diagnosis and therapeutic effect and outcome of diffuse axonal injury （DAI） in 169 patients. Methods ： The data of 169 DAI patients treated in the Second, Sixth, Eighth and Ninth Hospitals of Shenzhen and Shekou Hospital from January 2001 to January 2005 were collected. The imaging features, classification, GCS （Glasgow coma scale）, treatment and outcome of the 169 patients were retrospecti.vely analyzed. Results ： The simpler the imaging features, the closer the focus of DAI to the periphery of hemisphere and the higher the GCS score, the better the prognoses of DAI patients will be. Conclusions： The prognoses of DAI patients are closely related to the imaging features and classification, GCS and clinical treatment.
