急性肾炎合并肺嗜酸粒细胞浸润征4例报告

急性肾炎的主要并发症有高血压脑病,急性肾衰和急性循环充血甚至心力衰竭,合并肺嗜酸粒细胞(EC)浸润征尚未见报告,我们遇到4例,现将有关临床资料报告如下。

超声对微小肝实质病变良恶性诊断的多因素logistic分析及价值探讨

目的寻找早期筛查微小肝癌的敏感超声指标并对其诊断效能进行评估。方法第一阶段通过回顾性分析163例共163个直径≤2 cm肝实质性病变的超声特征,按病理结果分为良性和恶性两组,对两组间超声指标进行分析,找出对筛查微小肝癌敏感的超声指标;第二阶段用筛查出的超声敏感指标对临床拟诊肝实质性病变164例共178个直径≤2 cm病灶进行诊断效能评估。结果两组间年龄、性别、肝炎病史、酗酒差异无统计学意义(P>0.05);肿块形态、边界、回声强弱、动脉血流参数差异无统计学意义(P>0.05);病灶回声均匀度、浸润挤压征、晕征差异有统计学意义(P<0.05),其中浸润挤压征对良恶性鉴别贡献度较大(OR=60.712,P<0.001);其对微小肝癌诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为75.24%、95.89%、83.71%、96.34%、72.92%、18.31、0.78。结论超声浸润挤压征是早期筛查微小肝癌的敏感超声指标,对早期微小肝癌检出效能高,有较高的临床应用价值。

Coarse grain deposit feature of Guantao formation in western depression Shuyi area of Liaohe basin

The extensive distribution of coarse-grained clastic rock of Guantao formation in Shuyi area of Liaohe basin was considered as a result of fluvial deposit. According to the comprehensive analysis of seism data, well log, core observation and experimental data, this kind of clastic rock is composed of pebblestone-cobblestone, microconglomerate, sand conglomerate, medium-coarse grained sandstone and fine-sandstone. According to the clast composition, sedimentary texture, structure and rock type, 3 kinds of sediment facies can be recognized ie the mixed accumulation-conglomerate dominated debris flow, pebblestone-cobblestone dominated gradient flow and sandstone dominated braided stream. Vertically, the bottom gradient current deposit and top braided stream deposit form fining-upward sediment sequence, and the debris flow deposit distributes in them at random. The sedimentary feature of coarse grain clastic of Guantao formation in Shuyi area is accordant with proximal wet alluvial fan deposited in wet climate at foreland and this kind of alluvial fan is different from the traditional one.

A clinical study of thoracic esophageal carcinoma metastasis into abdominal lymph nodes

Objective The aim of this study was to analyze the potential of thoracic esophageal carcinoma to metas-tasize into abdominal lymph nodes. Methods The data on abdominal lymph node metastasis in 164 patients who had undergone resection of thoracic esophageal carcinoma were analyzed retrospectively and grouped according to tumor position in the upper, middle, or lower thoracic esophagus. The dif erence in tumor infiltration depth, dif erentiation degree, pathological type, pathological stage, and the metastasis rate in abdominal lymph nodes among the three groups was evaluated and the correlation of abdominal lymph node metastasis with tumor infiltra-tion depth, dif erentiation degree, and pathological type was analyzed. Results Clinical characteristics such as tumor infiltration depth, dif erentiation degree, pathological type, and pathological stage were not significantly dif erent between the patients with upper, middle, and lower thoracic esophageal carcinomas. Although there was a dif erence in the metastasis rate in abdominal lymph nodes between the three groups （6.9%, 27.4%, and 39.6% for the upper, middle, and lower thoracic esophageal carcinomas, respectively）, it was not statistical y significant. There was also no association between the rate of abdominal lymph node metastasis and tumor infiltration depth, dif erentiation degree, and pathological type. Conclusion Esophageal carcinoma specifical y metastasizes into lymph nodes. If the tumor infiltrates the upper thoracic submucosa, it could metastasize down to abdominal lymph nodes via the lymphatic cap-il ary net. The majority of esophageal carcinomas were of T1b or higher pathological stage at the diagnosis, indicating infiltration of the submucosa. Thus, tumors of the early stage, high degree of dif erentiation, or position in the upper thoracic esophagus were not less prone to metastasis into abdominal lymph nodes. Therefore, routine abdominal lymph node dissection during radical surgery for esophageal carcinoma is necessary.

Microsurgical Resection of Pituitary Adenoma via Single-Nostril Transsphenoidal Approach

OBJECTIVE To explore the methods and experience of thesingle-nostril transsphenoidal approach for treating pituitaryadenomas.METHODS We retrospectively analyzed 46 patients whohad pituitary tumors and received surgery via the singlenostriltranssphenoidal approach and observed the effects andcomplications of surgery. The specific surgical methods are: a nasalspeculum is inserted slowly through the right nostril towards theanterior wall of the sphenoid sinus. A 1.5 cm incision is made intothe nasal mucosa in the right nasal cavity at the level of the middlenasal turbinate. By fracturing the bony septum, a space is formedbetween the bilateral nasal mucosa and the bony septum of thesphenoid sinus. Then, the inside of the sphenoid sinus is exposed.The remaining part of the bony septum, the anterior sphenoidsinus wall, and the sphenoid mucosa are gradually removed. Theanterior sphenoidotomy is less than 1.5 cm wide. After confirmingthe tumor by dural puncture, a cross incision of the dura is made,and the tumor is slowly removed by curette. The sella is usuallycollapsed and visible after the total tumor removal. When thetumor is resected satisfactorily, gelatin sponges are placed into theoperative cavity to stop bleeding.RESULTS Postoperative MRI scans revealed that among the 46cases, total resection of the tumor was achieved in 34 cases andsubtotal in 12. No deaths or disability occurred, and the hormonelevels of almost all patients improved. Signs of diabetes insipidusoccurred in 17, electrolyte disturbances in 5, and there were noreports of postoperative cerebrospinal fluid rhinorrhea.CONCLUSION The direct single nostril transsphenoidalapproach of continuous improvement has the advantages ofa convenient approach, simplified operation, safety and highefficiency.