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Value of Ultrasonography in Diagnosis and Differentiation of Tumors of Adrenal Gland

【摘要】 目的 探讨超声显像对肾上腺肿瘤的定位、定性诊断与鉴别诊断价值。 方法 对 2003年1月-2009年1月125例疑为肾上腺肿瘤患者进行超声及CT检查，并经手术与病理证实。超声显像诊断后经手术与病理证实为嗜铬细胞瘤48例，肾上腺皮质腺瘤41例，皮质腺癌11例，肾上腺转移癌 9例，髓样脂肪瘤8例，结节样增生2例，肾上腺结核4例，胰尾部肿瘤1例，肝脏肿瘤1例，肾上极肿瘤1例。 结果 肾上腺肿瘤的病理类型不同，声像图表现亦各不相同。超声显像定位诊断符合率为96.0%（120/125），定性诊断符合率为91.2% （114/125）。 结论 超声显像对肾上腺肿瘤的定位与定性诊断价值较大，可作为临床诊断的首选检查方法。【Abstract】 Objective To assess the value of ultrasonography in the diagnosis and differential diagnosis of tumors of adrenal gland. Methods From January 2003 to January 2009, 125 patients who were suspected to suffering from adrenal tumors underwent ultrasonography and CT examination. The results were then confirmed by surgery and pathology. There were 48 cases of pheochromocytoma, 41 adenoma, 11 adenocarcinoma, 9 metastatic tumor, 8 adrenal medullary lipoma, 2 nubblar hyperplasia, 4 tuberculosis of adrenal gland, 1 tumor of cauda pancreatic, 1 tumor of liver and 1 tumor of upper pole of kidney. Results The ultrasonographic features varied with different pathological types. The accuracy diagnosis of localizition and qualitation were 96.0% (120/125) and 91.2% (114/125) respectively. Conclusion Ultrasonography is useful in diagnosing tumors of adrenal gland, which may be used as the first choice for the disease.

较大肾上腺肿瘤后腹腔镜术围手术期的护理

摘要:目的: 探讨直径＞6.0cm的肾上腺肿瘤患者经后腹腔镜手术围手术期的护理策略。 方法 :对我院近5年收治的27例肾上腺肿瘤(直径＞6.0cm)患者经后腹腔镜手术围手术期间实施同步护理,并将护理措施进行回顾性总结。 结果 :24例患者通过后腹腔镜术顺利切除肿瘤,术中术后未出现并发症,痊愈出院,3例患者中转为开放手术。 结论 :做好直径＞6.0cm的肾上腺肿瘤患者经后腹腔镜手术术前术后的护理配合,对促进伤口愈合,防止并发症发生起到佷重要的作用。

The Impact of Norepinephrine on Pulmonary Vein in Treating Septic Shock

以双眼中心性浆液性脉络膜视网膜病变首诊的肾上腺皮质癌1例

Changes and Significancy of Adrenomedullin, Atrial Natriuretic Polypeptide and Heart Rate Variability in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

Objective To investigate the changes and clinical relationship of plasma adrenomedullin( ADM) , atrial natriuretic polypeptide( ANP) , and heart rate variability( HRV) in patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods Seventy-five inpatients with OSAHS were enrolled in this study. According to the apnea hypopnea index ( AHI) by polysomnography, the subjects were divided into a mild group, a moderate group, and a severe group. Meanwhile, HRV was screened bydynamic electrocardiogram in sleep laboratory. HRV parameters were obtained including LF ( low frequency power) , HF( high frequency power) , pNN50( percentage of NN50 in the total number of N-N intervals) ,SDNN( standard deviation of the N-N intervals) , rMSSD( square root of the mean squared differences of successive N-N intervals ) . Plasma levels of ADM/ANP were measured by radioimmunoassay. Results The levels of SDNN ( P lt;0. 05) , rMSSD, pNN50, LF ( P lt; 0. 05) and HF were gradually reduced, and the levels of ADM ( P lt;0. 05) and ANP ( P lt; 0. 05) were increased with increasing severity of OSAHS. Linear correlation analysis demonstrated that SDNN was negatively correlated with ADM( r = - 0. 423, P lt;0. 05)and ANP( r = - 0. 452, P lt; 0. 05) , and LF was also negatively correlated with ADM( r = - 0. 348, P lt;0. 05) . Conclusion Lower HRV is associated with more sever OSAHS, and it may be modulated neurohumorally by ADM and ANP.

Role of Vasoactive Intestinal Peptide in Relaxation of the Lower Esophageal Sphincter in Human

Abstract：　Objective　To investigate the influence of vasoactive intestinal peptide （VIP) on the sling fibers and the clasp fibers of the lower esophageal sphincter （LES） and the difference， and explore whether VIP belongs to a nonadrenergic　and noncholinergic （NANC） neurotransmitter.　Methods　Thirty LES specimens were obtained from 30 patients with high-position carcinoma of the middle thoracic esophagus who underwent esophagectomy from March to August 2010 in Fourth Affiliated Hospital of Hebei Medical University. There were 14 male patients and 16 female patients with their average　age of 58.0±6.1 years. The clasp fibers and sling fibers were isolated and suspended in perfusion. Exogenous VIP was added to the two kinds of strips to draw a concentration-effect curve. Electric field stimulation （EFS） or exogenous VIP was applied to clasp fibers and sling fibers， and the influence of VIP （10-28） on LES was compared.　Results　ExogenousVIP in different concentration caused concentration-dependent relaxation of the sling fibers and clasp fibers of LES in vitro.　There was statistical difference in relaxation between the sling fibers and clasp fibers under same VIP concentration （P＜0.05），　and the relaxation of sling fibers was more significant than that of clasp fibers. VIP （10-28） transiently inhibited the relaxationof the sling fibers and clasp fibers caused by exogenous VIP. VIP （10-28） also transiently inhibited the relaxation of the sling fibers and clasp fibers after the activation of EFS.　Conclusion　The relaxation of sling fibers and clasp fibers induced by　EFS is related to VIP. VIP is a kind of NANC neurotransmitter in human LES.

Clinical Analysis of 17 Cases of Adrenocortical Hypofunction after Abdominal Operation

目的 探讨腹部手术后患者发生肾上腺皮质功能减退的临床特点及诊治方法。方法 回顾性总结分析我院自2003年1月至2006年12月期间行腹部手术8 974例患者中17例术后确诊为并发肾上腺皮质功能减退者的临床资料。结果 本组腹部手术后肾上腺皮质功能减退的发生率为0.19%（17/8 974），女性患者多于男性患者，男女之比约为1∶2； 其中55~64岁者2例，65~75岁者12例，75岁以上者3例。临床表现以嗜睡及消化道症状为主。实验室检查尿皮质醇水平降低，促肾上腺皮质激素兴奋试验阳性。1例出现肾上腺危象死亡，其余病例经激素治疗后康复。结论 腹部手术后肾上腺皮质功能减退多数病因不明确。临床以嗜睡及消化道症状为主要表现。实验室检查是确诊和激素治疗的依据。多预后良好，但发生肾上腺危象时仍可危及生命。

Effect of Serum of Pregnant patients with Intrahepatic Cholestasis on the Excretion of Corticotropin-Releasing Hormone in the Placental Tissue in Vitro

【摘要】 目的 观察妊娠肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）患者血清对体外培养的胎盘组织促肾上腺皮质激素释放激素（corticotropin-releasing hormone，CRH）的分泌水平的影响。 方法 收集2005年3月-7月在四川大学华西第二医院产科住院分娩的正常妊娠妇女胎盘组织及其血清（对照组）与ICP患者血清（ICP组）各10例。通过胎盘组织培养及放射免疫法测定其培养液中CRH水平。 结果 ICP组胎盘组织CRH分泌水平低于对照组，ICP组24、48、72、96 h分别为（84.95±34.98）、（74.57±29.93）、（71.16±27.26）、（81.07±37.18） pg/mL；对照组分别为（103.74±30.85）、（108.27±23.77） 、（109.20±23.81）、（118.15±26.84） pg/mL。两组比较，48h后差异有统计学意义（Plt;0.05）。 结论 ICP患者血清对体外培养的胎盘组织CRH分泌有抑制作用。【Abstract】 Objective To observe the effect of serum of pregnant patients with intrahepatic cholestasis (ICP) on the excretion level of corticotrophin-releasing hormone in the placental tissue in vitro. Methods Serum from 10 patients with ICP (ICP group) and from the healthy placental tissue of 10 normal people (control group) were collected from March to July, 2005. Cell culture and radioimmunoassay methods were used to investigate the corticotropin-releasing hormone (CRH) levels in placental tissue. Results The level of CRH in human placental tissue treated with sera of ICP was lower than that in the control group. 24, 48, 72, and 96 hours after treated with the serum, the levels of CRH in the ICP group were (84.95±34.98), (74.57±29.93), (71.16±27.26), and (81.07±37.18) pg/mL, respetively;while in the control group were (103.74±30.85), (108.27±23.77), (109.20±23.81), and (118.15±26.84) pg/mL, respectively. There was significant difference in the levels of CRH between ICP group and control group 48 hours after the culture (Plt;0.05). Conclusion The serum from the patients with ICP may inhibit the excretion of CRH in the placental tissue.

可疑肾上腺内异位甲状腺1例报道并文献复习

目的总结肾上腺内异位甲状腺的影像学表现、病理特征、临床诊断、鉴别诊断以及治疗方法和预后。方法回顾性分析2023年3月广东医科大学附属医院收治的1例可疑肾上腺内异位甲状腺的临床表现、病理特征、治疗及预后情况，并结合国内外相关文献报道的26例肾上腺内异位甲状腺的病例资料进行分析。结果本例66岁女性患者，术前检查提示左侧肾上腺占位（考虑嗜铬细胞瘤）并行手术完整切除，术后根据病理学检查和免疫组织化学检查最终考虑诊断为肾上腺内异位甲状腺并腺瘤样增生，术后随访6个月未见复发。复习国内外文献报道的26例肾上腺内异位甲状腺患者资料，亚洲中老年女性多见（22例），左侧多发（17例），大部分（19例）由体检发现，通常表现为无痛性囊性肿块，大体呈类圆形，镜下可见甲状腺样组织，并见甲状腺样滤泡，滤泡腔内见嗜酸性胶质样物，部分区域可见滤泡与肾上腺皮质混杂，通常无肾上腺髓质成分，囊壁被覆扁平上皮细胞或甲状腺滤泡样细胞、可见核重叠，偶见核沟和包涵体，类似甲状腺乳头状癌细胞核，但未见砂粒体。免疫组织化学表现为PCK、EMA、TTF-1、Tg、Vimentin阳性，提示甲状腺分化，BRAFV600E、KRAS基因突变阴性。治疗以完整切除肿瘤为主，预后良好。结论肾上腺内异位甲状腺罕见，确切发生机制有待研究，临床术前不易辨识，应与肾上腺肿瘤、转移性甲状腺滤泡癌、乳头状癌等鉴别，免疫组织化学染色及基因检测有助于明确诊断，治疗以完整切除肿瘤为主，预后良好。

泛素化在β2 肾上腺素能受体减敏中的作用

一直以来β2 受体激动剂在支气管哮喘的防治领域起着非常突出的作用, 但是由于长期重复使用后可致β2 肾上腺素能受体( β2 -adrenergic receptor, β2 AR) 减敏, 导致临床使用受到很大的限制。虽然现在已经开发出了长效的β2 受体激动剂, 但是也可因同样的原因需同时使用糖皮质激素以避免其可能的减敏 , 因此探讨β2 AR 减敏的机制就显得尤为必要。泛素系统包括泛素、多种酶、26S 蛋白酶体等, 细胞内许多蛋白都通过泛素化参与生命活动。有研究显示β2 AR 的泛素化与其内化和降解有关。本文就β2 AR 减敏的可能机制作一综述。