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Leiomyosarcoma of the inferior vena cava: a case report and review of the literature. 下腔静脉平滑肌肉瘤1例报告及文献复习。
Pub Date : 2009-07-01
Alberto Sartori, Silvia Vigna, Aldo Dal Pozzo, Maurizio Balduino, Carlo Augusto Sartori

Leiomyosarcoma of the inferior vena cava is a particularly rare tumour, originating from the smooth muscle of the vessel wall. The authors describe the case of a female patient admitted with a picture of anorexia and weight loss, accompanied by epi- and mesogastric pain. Preoperative examinations revealed the presence of a mass of considerable size originating from the inferior vena cava. The patient was submitted to surgery consisting in removal of the mass and of part of the wall of the vena cava. A review of the literature confirms the rarity of this tumour and demonstrates that optimal anatomical knowledge is absolutely indispensable for the management of this pathology.

下腔静脉平滑肌肉瘤是一种特别罕见的肿瘤,起源于血管壁的平滑肌。作者描述了一名女性患者入院的厌食症和体重减轻的图片,并伴有外胃和肠系膜疼痛。术前检查发现有一个相当大的肿块起源于下腔静脉。病人接受手术,包括切除肿块和部分腔静脉壁。对文献的回顾证实了这种肿瘤的罕见性,并表明最佳的解剖学知识对于这种病理的管理是绝对不可或缺的。
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引用次数: 0
Cryptogenetic intestinal angiodysplasia and elderly aortic stenosis: Heyde's syndrome? A case report. 隐源性肠血管发育不良和老年主动脉瓣狭窄:Heyde综合征?一份病例报告。
Pub Date : 2009-07-01
Walter Testi, Francesco Coratti, Carmen Staffieri, Riccardo Malatesti, Giulia Baldoni, Vanessa Borgogni, Bruno Lorenzi, Andrea Coratti, Francesco Tani

Gastrointestinal haemorrhage is extremely frequent, but in some cases the aetiology may remain unknown. Haemorrhage from the small bowel especially can create important diagnostic problems. We report the case of a patient admitted to hospital with intestinal bleeding in an ileal site in association with aortic stenosis. Enteric angiodysplasia is a frequent pathology in the surgery of the gastrointestinal tract. Recognizing bleeding lesions in the small intestine can be really difficult. Concerning the case reported here, the most probable diagnostic hypothesis is Heyde's syndrome, which is characterised by valvular aortic stenosis together with gastrointestinal bleeding due to cryptogenetic angiodysplasias. The choice to be made in the therapeutic management of angiodysplasia is still a debatable issue and should be suited to the patient's clinical state and the site and extent of the bleeding. In the literature the link between aortic valvular stenosis and intestinal angiodysplasia is unclear. The physiopathological relationship between the two entities is still mysterious.

胃肠道出血是非常常见的,但在某些情况下,病因可能仍不清楚。小肠出血尤其会产生重要的诊断问题。我们报告的情况下,病人入院与肠出血在回肠部位与主动脉瓣狭窄。肠道血管发育不良是胃肠道手术中常见的病理。识别小肠出血病灶是非常困难的。对于本文报道的病例,最可能的诊断假设是Heyde综合征,其特征是瓣膜性主动脉狭窄并伴有隐源性血管发育不良引起的胃肠道出血。在血管发育不良的治疗管理的选择仍然是一个有争议的问题,应该适合患者的临床状态和出血的部位和程度。在文献中,主动脉瓣狭窄与肠血管发育不良之间的联系尚不清楚。这两个实体之间的生理病理关系仍然是神秘的。
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引用次数: 0
[Prognostic significance of the Mandard TRG classification after induction therapy in carcinoma of the oesophagus and cardia]. [食管癌、贲门癌诱导治疗后标准TRG分型的预后意义]。
Pub Date : 2009-07-01
Andrea Zanoni, Giuseppe Verlatoa, Annamaria Minicozzi, Anna Tomezzoli, Simone Giacopuzzi, Mapriantonietta Di Cosmo, Ilaria Franceschetti, Edoardo Saladino, Giovanni De Manzoni

Mandard's tumor regression grade (TRG) is widely used to evaluate the pathological response to induction therapy with concurrent chemoradiotherapy in cancer of the oesophagus or gastro-oesophageal junction. The aim of this study was to evaluate the prognostic significance and clinical applicability of TRG. From 2000 to 2007, 108 patients with squamous cell carcinoma of the oesophagus (57 cases) or Siewert type I and II adenocarcinoma of the cardia (51 cases) were treated with induction chemoradiotherapy followed by surgery in the 1st Division of General Surgery of the University of Verona. The treatment was identical for all patients and consisted of cisplatin, 5 FU and docetaxel together with 50 Gy of concurrent radiotherapy. The treatment-induced response was evaluated by TRG. Fifty-one, 24, 17, 9 and 7 patients were classified, respectively, as TRG1, 2, 3 4 and 5. Fifty-two patients died of the disease. Disease-related survival decreased with the increase in TRG class in node-negative patients (p < 0.001), while in N+ patients it was poor, irrespective of TRG class (p = 0.241). Mandard TRG is therefore useful for staging patients undergoing preoperative chemoradiotherapy, because it displays high prognostic significance. In our study, however, N was the main prognostic factor and for this reason it is mandatory to consider nodal status along with TRG. Moreover, among N negative patients, the prognosis of each different TRG class is statistically different and for this reason different TRG classes cannot be grouped together.

manard肿瘤消退分级(TRG)被广泛用于评价食管癌或胃-食管交界处癌诱导治疗联合放化疗的病理反应。本研究的目的是评价TRG的预后意义和临床适用性。从2000年到2007年,维罗纳大学普通外科一科对108例食管鳞状细胞癌(57例)或siwert I型和II型贲门腺癌(51例)进行了诱导放化疗后手术治疗。所有患者的治疗方法相同,包括顺铂、5fu和多西他赛以及50 Gy的同步放疗。用TRG评价治疗诱导的反应。TRG1、2、3、4、5分别为51例、24例、17例、9例、7例。52名患者死于这种疾病。在淋巴结阴性患者中,疾病相关生存率随着TRG分级的增加而降低(p < 0.001),而在N+患者中,无论TRG分级如何,疾病相关生存率都较低(p = 0.241)。因此,标准TRG对术前放化疗患者的分期是有用的,因为它具有很高的预后意义。然而,在我们的研究中,N是主要的预后因素,因此必须将淋巴结状态与TRG一并考虑。此外,在N例阴性患者中,不同TRG分级预后有统计学差异,因此不能将不同TRG分级归为一类。
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引用次数: 0
[Iatrogenic lesion of the hepatic artery in the course of pancreatic surgery]. [胰腺手术过程中肝动脉的医源性病变]。
Pub Date : 2009-07-01
Fausto Rosa, Fabio Pacelli, Valerio Papa, Antonio Pio Tortorelli, Maurizio Bossola, Giovanni Battista Doglietto

The authors report a case of operative injury of the hepatic artery during a total spleno-pancreasectomy procedure for a mixed-type intraductal papillary mucinous neoplasm. During the preparation of the structures of the hepatic pedicle, a "true" hepatic artery was not identified, but only a small arterial vessel measuring about 2 mm in diameter, just in front of the portal vein, apparently emerging from the parenchyma of the pancreatic head. To obtain complete mobilisation of the duodeno-pancreatic block from the portal vein, it was necessary to cut this small arterial vessel. In the postoperative period, the patient developed extensive liver ischaemia, which was gradually resolved, but resulted in multiple stenosis of the intra- and extra-hepatic biliary tree. At follow-up at three years, the patient was in fairly good condition, with a permanent percutaneous biliary drainage, but with no clinical or radiological signs of local or distant disease. Although interruption of hepatic arterial flow is usually well tolerated, this is not always the case. It is important to predict in what circumstances complications are likely to occur. The main determinants that should guide the surgeon faced with this problem are whether the portal circulation is normal, whether structures carrying collateral blood supply have been interrupted, and whether some form of biliary reconstruction is needed.

作者报告一例手术损伤肝动脉在全脾胰切除术过程中混合型导管内乳头状粘液瘤。在肝蒂结构的制备过程中,没有发现“真正的”肝动脉,只有一个直径约2mm的小动脉血管,就在门静脉的前面,显然是从胰头的实质中出现的。为了从门静脉获得完全的十二指肠胰阻滞,有必要切断这条小动脉血管。术后患者出现大面积肝缺血,逐渐缓解,但肝内及肝外胆道多发狭窄。随访三年,患者状况良好,经皮永久性胆道引流,但没有局部或远处疾病的临床或影像学征象。虽然肝动脉血流的中断通常是可以容忍的,但情况并非总是如此。预测在什么情况下可能发生并发症是很重要的。指导外科医生面对这个问题的主要决定因素是门静脉循环是否正常,携带侧支血液供应的结构是否被中断,以及是否需要某种形式的胆道重建。
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引用次数: 0
[Emergency laparoscopic cholecystectomy in the treatment of acute cholecystitis: when and how?]. 急诊腹腔镜胆囊切除术治疗急性胆囊炎:何时及如何?
Pub Date : 2009-07-01
Marco Catani, Ritanna De Milito, Francesco Romagnoli, Giovanni Luciani, Luigi Simonelli, Valentina Carocci, Valentina Usai, Vania Silvestri, Claudio Modini

Optimal surgical timing and operative technique in the treatment of acute cholecystitis are of major importance and are still debatable issues. We report the results of our study on the timing of surgery in a consecutive series of 163 patients treated in the emergency setting for acute cholecystitis over the period from 1998 to 2008. Early surgery and the partially downwards laparoscopic cholecystectomy technique provide a safe and effective way of treating these patients and preventing major complications. The mean time period between onset of symptoms and surgery was 69.2 hrs, with a median value of 53 hrs. The mean operative time was 63.9 min, with a conversion rate of 0.6% and a specific complication rate of 1.22%. The mean postoperative hospital stay was 3.2 days. The timing of surgery (measured in hours) and operative time (measured in minutes) were recorded and analysed to verify whether or not there was a statistically significant relationship between these two variables and establish the best timing for surgery. Our results show a linear relationship between operative time and the timing of surgery. Moreover, at the cut-off point of 57 hrs, the later subgroup (over 57 hrs) had a two-fold increase in operative time compared to the earlier subgroup. At more than 60 hrs approximately from the onset of symptoms, the pathological changes in the surgical target begin, with increasing rapidity, to present a troublesome challenge to the surgeon, making laparoscopic cholecystectomy for acute cholecystitis more difficult and less safe than when performed earlier.

最佳的手术时机和手术技术在治疗急性胆囊炎是重要的,仍然是有争议的问题。我们报告了我们对1998年至2008年期间急诊治疗的163例急性胆囊炎患者手术时间的连续研究结果。早期手术和部分下行腹腔镜胆囊切除术技术为治疗这些患者提供了安全有效的方法,并预防了重大并发症。从出现症状到手术的平均时间为69.2小时,中位数为53小时。平均手术时间63.9 min,转换率0.6%,特定并发症发生率1.22%。术后平均住院时间为3.2天。记录并分析手术时间(以小时为单位)和手术时间(以分钟为单位),以验证这两个变量之间是否存在统计学意义上的关系,并确定最佳手术时间。我们的结果显示手术时间和手术时间之间存在线性关系。此外,在57小时的分界点,较晚亚组(超过57小时)的手术时间比较早亚组增加了两倍。大约在症状出现后60小时以上,手术目标的病理变化开始以越来越快的速度给外科医生带来麻烦的挑战,使急性胆囊炎的腹腔镜胆囊切除术比早期手术更加困难和不安全。
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引用次数: 0
[Surgical approach in the management of oesophageal tumours: considerations based on therapeutic results]. [食道肿瘤的手术治疗:基于治疗结果的考虑]。
Pub Date : 2009-07-01
Alessandro Longhini, Francesco Della Nave, Alessandro Grechi, Amir Reza Kazemian, Gianluca Munarini, Giuseppe Marcolli

Over the last two decades, oesophageal cancers, although considered among the most malignant visceral tumours, have witnessed a gradual increase in survival rates at a distance after surgery. The aims of the study were to present the results of our surgical approach and, on this basis, to discuss a number of considerations regarding the type of intervention to be adopted. In a retrospective study we recruited 105 patients with oesophageal cancer treated with various types of oesophageal resection, with or without thoracotomy, in the Division of General Surgery of the Civic Hospital of Sondrio. The postoperative mortality rate was 12%, with 40.2% of non-lethal complications. The average overall survival, whether in patients R0 or not, was 31.2 months (range: 1-167), with actuarial survival rates of 63.2% at one year, 30.3% at three years and 22.1% at five years. This was not significantly influenced by the type of surgery or by the location or histology of the cancer, while TNM stage, degree of parietal infiltration and the presence or absence of lymph-node metastases were significant factors. Although we limited the lymphadenectomy to "standard or extended two-field" operations, our overall survival at five years was similar to that of surgeons advocating much more extensive lymphadenectomy. In our case most of the relapses occurred at the systemic level and in the short term, on average after 12.7 months, meaning that micrometastases were probably already present at the time of intervention (82.4% of these patients, in fact, had stage N1 cancers). We prefer cervical anastomosis owing to the possibility it affords of greater oesophageal resection and to its relative safety in case of dehiscence. We always perform a right cervicotomy, which allows us to avoid having to move the patient on the operating table and to have fewer injuries to the recurrent nerve.

在过去的二十年中,食管癌虽然被认为是最恶性的内脏肿瘤之一,但手术后的远距离生存率逐渐增加。本研究的目的是介绍我们的手术方法的结果,并在此基础上讨论有关采取干预措施的一些考虑因素。在一项回顾性研究中,我们在Sondrio市立医院普通外科招募了105例食管癌患者,他们接受了各种类型的食管切除术,有或没有开胸。术后死亡率为12%,非致死性并发症发生率为40.2%。无论患者是否为R0,平均总生存期为31.2个月(范围:1-167),精算生存率为1年63.2%,3年30.3%,5年22.1%。这与手术类型、肿瘤的位置或组织学没有明显关系,而TNM分期、顶骨浸润程度和有无淋巴结转移是重要因素。虽然我们将淋巴结切除术限制为“标准或扩展的双野”手术,但我们5年的总体生存率与主张更广泛的淋巴结切除术的外科医生相似。在我们的病例中,大多数复发发生在全身水平和短期内,平均在12.7个月后,这意味着微转移可能在干预时已经存在(事实上,这些患者中有82.4%为N1期癌症)。我们更倾向于颈吻合术,因为它有可能提供更大的食管切除,并且在裂口的情况下相对安全。我们总是进行右颈切开术,这使我们避免了在手术台上移动病人,也减少了对复发神经的伤害。
{"title":"[Surgical approach in the management of oesophageal tumours: considerations based on therapeutic results].","authors":"Alessandro Longhini,&nbsp;Francesco Della Nave,&nbsp;Alessandro Grechi,&nbsp;Amir Reza Kazemian,&nbsp;Gianluca Munarini,&nbsp;Giuseppe Marcolli","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Over the last two decades, oesophageal cancers, although considered among the most malignant visceral tumours, have witnessed a gradual increase in survival rates at a distance after surgery. The aims of the study were to present the results of our surgical approach and, on this basis, to discuss a number of considerations regarding the type of intervention to be adopted. In a retrospective study we recruited 105 patients with oesophageal cancer treated with various types of oesophageal resection, with or without thoracotomy, in the Division of General Surgery of the Civic Hospital of Sondrio. The postoperative mortality rate was 12%, with 40.2% of non-lethal complications. The average overall survival, whether in patients R0 or not, was 31.2 months (range: 1-167), with actuarial survival rates of 63.2% at one year, 30.3% at three years and 22.1% at five years. This was not significantly influenced by the type of surgery or by the location or histology of the cancer, while TNM stage, degree of parietal infiltration and the presence or absence of lymph-node metastases were significant factors. Although we limited the lymphadenectomy to \"standard or extended two-field\" operations, our overall survival at five years was similar to that of surgeons advocating much more extensive lymphadenectomy. In our case most of the relapses occurred at the systemic level and in the short term, on average after 12.7 months, meaning that micrometastases were probably already present at the time of intervention (82.4% of these patients, in fact, had stage N1 cancers). We prefer cervical anastomosis owing to the possibility it affords of greater oesophageal resection and to its relative safety in case of dehiscence. We always perform a right cervicotomy, which allows us to avoid having to move the patient on the operating table and to have fewer injuries to the recurrent nerve.</p>","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 4","pages":"449-60"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28451995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Laparoscopic lavage and drainage in the surgical treatment of diverticular disease complicated by peritonitis]. 腹腔镜灌洗引流在憩室病并发腹膜炎手术治疗中的应用
Pub Date : 2009-07-01
Carlo Ettore Lippi, Luca Beatini, Silvio Cervia, Alaido Fabbricotti, Piero Antonio Miaruelli, Elisabetta Spessa, Ivarco Sturlese, Andrea Braini

The treatment of peritonitis complicating diverticular disease of the colon is yet to be universally regarded as established practice and major differences in management are to be noted in the various surgical institutions. In the emergency setting, the minimally invasive approach is used by few surgeons and the most frequent therapeutic options are sigmoid resection with primary anastomosis (with or without a diverting stoma) and Hartmann's procedure. The Authors report their preliminary experience (13 cases) with laparoscopic lavage and drainage without colonic resection in diverticulitis complicated by peritonitis and describe the technical details of the surgical procedure. They conduct a systematic review of the literature and, on the basis of their latest experience, compare the results of the traditional resective operations (resection with primary anastomosis and Hartmann's procedure) with those of laparoscopic conservative and non-resective treatment. Laparoscopic non-resective procedures reduce the frequency and severity of the surgical complications, as well as the hospital stay and costs of treatment. In conclusion, laparoscopic lavage and drainage can be used in the majority of patients, with excellent prospects of recovery, without disabling stomas, in a single operative stage.

腹膜炎并发结肠憩室病的治疗尚未被普遍认为是既定的做法,各外科机构在管理上的主要差异是值得注意的。在急诊情况下,很少有外科医生采用微创入路,最常见的治疗选择是乙状结肠切除术加一期吻合(带或不带转移造口)和Hartmann手术。作者报告了13例腹腔镜下不切除结肠灌洗引流治疗憩室炎并发腹膜炎的初步经验,并描述了手术的技术细节。他们对文献进行了系统的回顾,并根据他们的最新经验,比较了传统切除手术(一期吻合切除和Hartmann手术)与腹腔镜保守和非切除治疗的结果。腹腔镜非切除手术减少了手术并发症的频率和严重程度,以及住院时间和治疗费用。综上所述,腹腔镜灌洗引流术可用于大多数患者,在单期手术中恢复前景良好,不致残造口。
{"title":"[Laparoscopic lavage and drainage in the surgical treatment of diverticular disease complicated by peritonitis].","authors":"Carlo Ettore Lippi,&nbsp;Luca Beatini,&nbsp;Silvio Cervia,&nbsp;Alaido Fabbricotti,&nbsp;Piero Antonio Miaruelli,&nbsp;Elisabetta Spessa,&nbsp;Ivarco Sturlese,&nbsp;Andrea Braini","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The treatment of peritonitis complicating diverticular disease of the colon is yet to be universally regarded as established practice and major differences in management are to be noted in the various surgical institutions. In the emergency setting, the minimally invasive approach is used by few surgeons and the most frequent therapeutic options are sigmoid resection with primary anastomosis (with or without a diverting stoma) and Hartmann's procedure. The Authors report their preliminary experience (13 cases) with laparoscopic lavage and drainage without colonic resection in diverticulitis complicated by peritonitis and describe the technical details of the surgical procedure. They conduct a systematic review of the literature and, on the basis of their latest experience, compare the results of the traditional resective operations (resection with primary anastomosis and Hartmann's procedure) with those of laparoscopic conservative and non-resective treatment. Laparoscopic non-resective procedures reduce the frequency and severity of the surgical complications, as well as the hospital stay and costs of treatment. In conclusion, laparoscopic lavage and drainage can be used in the majority of patients, with excellent prospects of recovery, without disabling stomas, in a single operative stage.</p>","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 4","pages":"467-74"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28451997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Focal liver lesions: clinical usefulness of contrast-enhanced ultrasound in the selection of surgical patients]. [局灶性肝脏病变:超声造影在手术患者选择中的临床应用]。
Pub Date : 2009-05-01
Tommaso Vincenzo Bartolotta, Luigi Sandonato, Adele Taibbi, Stefania Latteri, Maurizio Soresi, Giuseppina Lombardo, Claudio Genova, Mario Adelfio Latteri

The aim of the study was to evaluate the role of contrast-enhanced ultrasound (CEUS) in the characterisation of focal liver lesions and for the selection of surgical patients. One hundred and thirty-five consecutive patients (71 women, 64 men) with 165 focal liver lesions (mean size: 3.1 cm)--89 benign (10 simple cysts, 26 haemangiomas, 29 focal nodular hyperplasia, 2 hepatocellular adenomas, 11 focal fatty sparing, 3 focal fatty areas, 5 regenerative nodules, 2 hydatid cysts, 1 abscess) and 76 malignant (47 metastases, 26 hepatocellular carcinomas and 3 peripheral cholangiocarcinomas)--underwent CEUS after the administration of SonoVue. Two radiologists reviewed baseline US and CEUS scans obtained 25-30 sec (arterial phase), 55-80 sec (portal-venous phase), and 235-260 sec (late phase) after initiating SonoVue injection, respectively. The radiologists classified each lesion as malignant or benign on the basis of clearly defined diagnostic criteria. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. CEUS correctly characterised 156/165 focal liver lesions (94.5%), 85 benign and 71 malignant. Five focal liver lesions (3%; 3 haemangiomas and 2 hepatocellular carcinomas) remained undetermined after CEUS and 4 focal liver lesions (2.4%; 3 hepatocellular carcinomas and 1 abscess) were misdiagnosed. CEUS presented sensitivity, specificity, and diagnostic accuracy values of 93.4%, 95.5% and 94.7% respectively. Positive and negative predictive values were 94.7% and 94.4%, respectively. CEUS is a useful tool in the characterisation of focal liver lesions and for selecting surgical patients.

该研究的目的是评估对比增强超声(CEUS)在局灶性肝脏病变特征和手术患者选择中的作用。135例连续患者(71例女性,64例男性)有165个局灶性肝脏病变(平均大小:3.1 cm),其中89例为良性(10例单纯性囊肿,26例血管瘤,29例局灶性结节增生,2例肝细胞腺瘤,11例局灶性脂肪保留,3例局灶性脂肪区,5例再生结节,2例包囊囊肿,1例脓肿),76例恶性(47例转移,26例肝细胞癌和3例外周胆管癌),在给予SonoVue后接受了超声造影。两名放射科医生回顾了开始注射SonoVue后25-30秒(动脉期)、55-80秒(门静脉期)和235-260秒(晚期)的基线US和CEUS扫描结果。放射科医生根据明确的诊断标准将每个病变分为恶性或良性。计算敏感性、特异性、阳性预测值、阴性预测值和诊断准确率。超声造影正确诊断了165个局灶性肝脏病变中的156个(94.5%),其中85个为良性,71个为恶性。5个局灶性肝脏病变(3%;3个血管瘤和2个肝细胞癌)在超声造影后仍未确定,4个局灶性肝脏病变(2.4%;3例肝细胞癌,1例脓肿)被误诊。超声造影的敏感性、特异性和诊断准确率分别为93.4%、95.5%和94.7%。阳性预测值为94.7%,阴性预测值为94.4%。超声造影是诊断局灶性肝脏病变和选择手术患者的有效工具。
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引用次数: 0
Giant nodular pseudoangiomatous stromal hyperplasia (PASH) of the breast presenting as a rapidly growing tumour. 乳腺巨大结节性假性血管瘤间质增生(PASH)表现为快速生长的肿瘤。
Pub Date : 2009-05-01
Maurizio Mezzabotta, Silvia Riccardi, Simona Bonvini, Paolo Declich, Enrico Tavani, Eugenio Morandi

Pseudoangiomatous stromal hyperplasia (PASH) is often a microscopic incidental finding in breast biopsies performed for benign or malignant diseases. In rare cases, it presents as a localised breast mass. Since Vuitch et al first described this condition in 1986, only 109 cases of PASH presenting as a palpable or mammographically detectable mass have been documented. PASH is characterised by a dense, collagenous proliferation of mammary stroma, forming inter-anastomosing capillary-like spaces. It is important to distinguish this benign lesion from a low-grade angiosarcoma. Here we describe the clinical, radiological and histological features of a very unusual case of PASH that presented as a rapidly growing breast lesion in a 37-year old woman.

假性血管瘤间质增生(PASH)通常是在乳腺活检中偶然发现的良性或恶性疾病。在极少数情况下,它表现为局部乳房肿块。自1986年Vuitch等人首次描述这种情况以来,仅有109例PASH被记录为可触及或乳房x光检查可检测到的肿块。PASH的特征是致密的、胶原增生的乳腺间质,形成相互吻合的毛细血管样间隙。将这种良性病变与低级别血管肉瘤区分开来很重要。在这里,我们描述了一个非常不寻常的PASH病例的临床、放射学和组织学特征,该病例表现为一个37岁的女性快速增长的乳房病变。
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引用次数: 0
Parastomal hernia repair with the use of Parietex composite mesh: a technical note. 使用Parietex复合补片修复造口旁疝:技术说明。
Pub Date : 2009-05-01
Lino Succi, Nnawuihe Luca Ohazuruike, Conchita Emanuela Oliveri, Antonino Carlo Privitera, Serafina Prumeri, Antonino Politi, Giuseppe Randazzo

Parastomal hernia is an incisional hernia related to an abdominal wall stoma. The incidence ranges from 5 to 50% and only 10% of these require surgical treatment. The authors propose an innovative surgical technique for treatment of parastomal hernia. Many kinds of repair for paracolostomal hernias have been proposed: simple fascia repair, stoma relocation and repair with prosthetic devices. We describe a successful local repair and a new approach to treat this defect using a polypropylene mesh.

造口旁疝是一种与腹壁造口有关的切口疝。发病率从5%到50%不等,其中只有10%需要手术治疗。作者提出了一种治疗造口旁疝的创新手术技术。结肠旁疝的修复方法有:单纯筋膜修复、造口移位和假体修复。我们描述了一个成功的局部修复和使用聚丙烯网治疗这种缺陷的新方法。
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引用次数: 0
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Chirurgia italiana
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