目的:明确脊柱骨巨细胞瘤的多层螺旋CT、MRI表现。方法:回顾性分析经病理证实的脊柱骨巨细胞瘤6例(男5例,女1例,年龄21～40岁,平均32岁)。6例CT检查,3例有MRI检查。结果:发生于胸椎3例,腰椎1例,骶椎2例。CT主要表现为膨胀性溶骨性破坏和较大软组织肿块;MRI表现T1加权成像为低等信号,T2加权成像为高低混杂信号特点,可显示瘤内坏死、囊变、出血等。结论:脊柱骨巨细胞瘤具有侵袭性强、生长活跃、易复发等特点,结合CT、MRI检查可对该病做出及时诊断,且对临床分期、手术方案制订及术后定期随访有重要价值。
From 1979, a total of 5 cases of giant cell tumor of the lower end of radius were treated by segmental resection, and vascularized fibular head transplantation, and reconstruction of the inferior radio-ulnar joint. The bone healed within 2-3 months. The patients were followed for 5-10 years. There was no recurrence, nor distant metastasis, and the functional recovery of extremities was satisfactory.The clinical materials, the operative techniques and the assessment of the long-term results were introduced.
目的 研究无创通气(NIPPV)治疗对肾移植术后巨细胞病毒(CMV)肺炎患者的疗效。方法 1998年1月~2005年12月间入住中山大学附属第一医院内科重症监护病房(MICU)的78例肾移植术后CMV肺炎患者，根据是否接受无创通气治疗而分为非NIPPV组和NIPPV组，比较两组患者在接受有创机械通气比例、病死率、住院时间及并发症等方面的差异。对52例NIPPV组患者，比较无创通气治疗前后生命体征及血气分析指标的变化。结果 NIPPV组与非NIPPV组相比，接受有创机械通气比例(30.8％ 比80.8％)、医院获得性肺炎发生率（32.7％ 比61.5％)及病死率(30.8％ 比57.7％)较低，两组比较均有显著性差异(P均lt;0.05)；而住院时间、气压伤发生率无显著差异。NIPPV组患者无创通气治疗后患者呼吸频率有所减慢，动脉血pH值逐渐降低，PaCO2水平缓慢上升，PaO2、PaO2 ／FiO2及SaO2明显升高，两组比较均有显著差异(P均lt;0.05)。而无创通气治疗前后心率、血压的变化则无明显规律。结论 NIPPV治疗能够改善肾移植术后CMV肺炎患者的低氧血症，缓解呼吸窘迫症状，降低有创机械通气治疗比例及医院获得性肺炎的发生率，从而降低病死率。用无创通气治疗巨细胞病毒肺炎值得在临床上推广使用。
To evaluate the effectiveness of tumor-segmental resection and autologous il iac bone graft reconstruction combined with internal fixation in treating hand-foot-giant cell tumor of bone. Methods Between August 1997 and April 2008, 8 cases of hand-foot-giant cell tumor of bone were treated, including 3 males and 5 females with an average age of 28.5 years (range, 16-42 years). The locations were metacarpal bones in 3 cases, metatarsal bones in 4 cases, and phalanges of toes in 1 case. According to Campanacci’s gradation of X-ray films, there were 1 case of grade I and 7 cases of gradeII; according to pathological examination before opration, there were 3 cases of grade I to II, 4 cases of grade II, and 1 case of grade II to III; and according to TNM staging, there were 1 case of TisN0M0, 4 cases of T1N0M0, and 3 cases of T2N0M0. There were 2 cases of recurrence, the time from the first operation to recurrence were 11 and 14 months, respectively. The tumor size was 1.8 cm × 1.0 cm to 6.0 cm × 2.0 cm, the cortical bone became thinner, and the boundary between tumor and periosteum was clear. All patients underwent tumor-segmental resection combined with autologous il iac bone graft reconstruction, and miniplate internal fixation by lumbar anesthesia or trachea cannula anesthesia. Results All incision healed by first intention. Eight patients were followed up 10 to 84 months with an average of 46 months. Radiographs showed that fracture union was achieved at 3 to 9 months (mean, 5 months). No significant rotation, angular, and shortening deformity occurred in il iac bone graft. The function of il iac bone donor site recovered excellently. The pathological examination showed giant cell tumor of bone in all cases, including 2 case of grade I-II, 5 cases of grade II, and 1 case of grade II-III. The hand or foot function recovered excellently. No tumor recurrence or lung metastasis occurred during follow-up. Conclusion Tumor-segmental resection combined with autologous il iac bone graft reconstruction plus internal fixation has excellent effectiveness for hand-foot-gaint cell tumor of bone.
目的：探讨喉巨细胞瘤的临床病理学特征及诊断、鉴别诊断要点.方法：报道1例喉巨细胞瘤，结合文献对其临床表现、影像学情况、病理形态学特点及鉴别诊断进行分析和探讨。结果：巨细胞瘤好发于长骨末端，约5%累及扁骨，不足5%的病例累及手足部的短管状骨，2%发生于头颈部。喉巨细胞瘤极罕见，发病平均年龄为42.4岁，男性多见。本例34岁，男性，左侧声门下3 cm×2 cm×2 cm肿块。镜下表现为圆形、卵圆形单核细胞及均匀分布其间的破骨细胞样巨细胞混合组成。结论：喉巨细胞瘤罕见，临床易误诊为恶性肿瘤，其病理学检查有特征性形态改变，结合影像学改变，可以确诊。
ObjectiveTo observe the clinical features of cytomegalovirus (CMV) retinitis (CMVR)-related uveitis after hematopoietic stem cell transplantation (HSCT).MethodsA retrospective clinical study. From October 2015 to May 2020, 14 cases of 21 eyes of CMVR patients with CMVR after HSCT confirmed by the ophthalmological examination of The First Affiliated Hospital of Soochow University were included in the study. Among them, there were 5 males with 8 eyes and 9 females with 13 eyes. The average age was 35.12±12.24 years old. All the affected eyes were examined by slit lamp microscope combined with front lens and fundus color photography. At the same time, fluorescein fundus angiography (FFA) was performed to examine 10 eyes of 5 cases; 3 cases of 3 eyes were examined for inflammatory cytokines in aqueous humor. All eyes received intravitreal injection of ganciclovir; patients with a history of systemic CMV infection received intravenous infusion of ganciclovir/foscarnet. The retinal lesions in the eye were completely resolved or the aqueous CMV-DNA was negative as a cure for CMVR. The uveitis symptoms, signs, FFA manifestations and the test results of inflammatory factors in aqueous humor before and after the CMVR cure was observed. The follow-up time after CMVR was cured was 3-42 months, and the average follow-up time was 14.28±13.12 months.ResultsAll eyes with CMVR were diagnosed with retrocorneal dust and/or stellate keratic precipitates (KP), anterior chamber flare and cells, and varying degrees of vitreous flocculent opacity; the retina was typical of a mixture of hemorrhage and yellow-white necrosis like "scrambled eggs with tomatoes". After CMVR was cured, there were 16 eyes (71.4%, 10/14) in 10 cases with KP, anterior chamber flare, cell and vitreous opacity. FFA examination revealed that the majority of retinal leakage during the active period of CMVR was necrotic foci and surrounding tissues; after CMVR was cured, the majority of retinal leakage was the retina and blood vessels in the non-necrotic area. The test results of inflammatory factors in aqueous humor showed that interleukin (IL)-6, IL-8, and vascular endothelial cell adhesion molecules were significantly increased in the active phase of CMVR; after 3 months of CMVR cured, inflammatory factors did not increase significantly.ConclusionCMVR-associated uveitis after HSCT show as chronic panuveitis, with no obvious eye congestion, KP, anterior chamber flare, cell and vitreous opacity, and retinal vessel leakage which could exist for a long time (＞3 months).