To investigate the diagnosis, pathological characteristics and clinical treatment of gastric eosinophilic granuloma (GEG). Twenty two cases with GEG diagnosed by operation and pathology were analyzed. In this series 14 cases subjected to partial gastrectomy, 6 cases to subtotal gastrectomy, 1 case to total gastrectomy, and 1 case to radical gastrectomy. After 1-10 years of follow-up, 1 case, who was combined with gastric carcinoma at the first operation, died of the recurrence and extensive metastasis of gastric carcinoma on the 4th year after operation, 2 cases were reoperated on the 2nd or 6th year respectively after operation for forward complication, and the others recoverd well. The authors consider that gastrofiberscopic diagnosis is key to lessen the preoperative misdiagnosis, and the scope of dissection mainly depends on the size and type of focus. It is no need for extensive dissection.
Objective To analyze the data from patients with pathologically proved granulomatous lung disease, including etiology, clinical, radiological features and laboratory results. Methods 36 patients with granulomatous lung disease confirmed by lung biopsy in Shanghai First People’s Hospital of Shanghai Jiao Tong University from January 2008 to June 2012 were retrospectively reviewed. The clinical presentation, radiological features and laboratory results were collected and statistically analyzed.Results After haematoxylin and eosin stain combined with special stain, the diagnoses were comfirmed, ie.13 cases of mycobacterial infection, 5 cases of aspergillar infection, 4 cases of cryptococcal infection, 6 cases of sarcoidosis, 4 cases of Wegener’s granulomatosis, 4 cases of unknown causes. Cough was the most common clinical symptom, followed by expectoration. Some patients also developed fever, chest tightness and weight loss. The lesions were widely distributed, of which the right upper lung was the common lesion of mycobacterial infection, inferior lobe of right lung was the common lesion of aspergillar infection. The common lesion of cryptococcal infection was uncertain. The common lesions of sarcoidosis and Wegener ’s granulomatosis were in left upper lung. Small nodule was the most common shapes of lesion, while mass and consolidation were present sometimes. Cavity, air bronchogram, pleural effusion, hilar and mediastinal lymph node enlargement could be found in the chest CT. Interferon gamma release assay, galactomannan antigen assay and latex agglutination test were helpful in the diagnosis of mycobacterial infection, aspergillar infection and cryptococcal infection induced granuloma. Conclusions The clinical presentations and radiological features of granulomatous lung disease are nonspecific. Histopathology obtained through biopsy is the key for the diagnosis. Immunological examination, test of new antigens to microorganism and clinical microorganism detection are valuble in the diagnosis and differential diagnosis of granulomatous lung disease.
Objective To investigate the operative procedure and the effectiveness of eosinophil ic granuloma (EG) of long bones in children. Methods Between January 2005 and December 2009, 14 patients with EG of long bones were treated. There were 9 boys and 5 girls, aged from 1 to 13 years (mean, 6.5 years). The locations were femur in 5 cases, humerus in 4 cases, tibia in 2 cases, fibula in 1 case, and femur compl icated with tibia in 2 cases. The disease duration was7 days to 10 months (median, 2 months). X-ray films showed that osteolytic destruction had clear boundary, which did notinvolve the epi physeal plate. Of 14 cases, 12 cases of tumor were treated by curettage, autologous il iac bone or combined artificial bone graft repair, and 2 cases were treated by resection, autologous il iac reconstruction, plate and screw fixation. Five cases compl icated with pathological fracture underwent reduction and fixation. Results All cases were diagnosed pathologically as having EG. All incisions healed by first intention. A total of 12 patients were followed up 1 to 4 years (mean, 2 years). The X-ray films showed tumor focus and pathological fracture healed within 3 to 4 months (mean, 3.5 months). Tibial lesion was found in 1 case of femoral tumor after 8 months, and was curred after reoperation. No recurrence occurred in other 11 cases. According to comprehensive assessing standard of X-ray film and joint function, the results of all cases were excellent. Conclusion EG of long bones in children is more common in the femur and humerus. Tumor curettage and autologous il iac bone graft repair is an effective method, and postoperative prognosis is good. There may be multiple lesions, so long-term follow-up is needed.
【摘要】 目的 探讨黄色肉芽肿性胆囊炎的诊断与治疗，提高对该疾病的认识及诊治水平。 方法 对2004年9月-2009年10月确诊为黄色肉芽肿性胆囊炎的15例患者资料进行回顾性分析。 结果 确诊为黄色肉芽肿性胆囊炎3例，慢性胆囊炎8例，胆囊癌4例。10例行胆囊切除术，2例行胆囊切除加胆总管探查T管引流术，1例行胆囊大部切除加十二指肠瘘修补术，1例行胆囊大部切除加胃瘘修补术，1例行胆囊切除加胆囊床部肝组织切除。术后并发胆瘘1例，切口感染2例。无死亡病例。 结论 黄色肉芽肿性胆囊炎术前难诊断，术中冷冻切片检查和术后病理检查是诊断的关键，手术切除胆囊是主要治疗方法。【Abstract】 Objective To evaluate the clinical diagnosis and treatment of xanthogranulomatous cholecystitis. Methods The clinical data of 15 patients with xanthogranulomatous cholecystitis treated in our hospital from September 2004 to October 2009 were retrospectively analyzed. Results All of 15 patients were diagnosed as xanthogranulomatous cholecystitis through postoperative pathologic examination, including 3 were diagnosed as xanthogranulomatous cholecystitis, 8 were diagnosed as chronic cholecystitis, and 4 were diagnosed as gallbladder carcinoma. All patients underwent the operations including cholecystectomy in 10, cholecystectomy plus choledochojejunostomy and T tube drainage in 2, gallbladder subtotal plus duodenal fistula in 1, gallbladder subtotal resection of gastric fistula in 1, and cholecystectomy plus the department of the gallbladder bed resection of liver tissue in 1. The postoperative complications included biliary fistula in 1 case and wound infection in 2 cases;no deaths were found. Conclusion Xanthogranulomatous cholecystitis is difficult to diagnose before the operations. The keys of the diagnosis are the intraoperative frozen section examination and postoperative pathologic examination. Cholecystectomy is the main operation for xanthogranulomatous cholecystitis.