Thyroid cancer

March 21st, 2011 by admin


Thyroid cancer (thyroid carcinoma) is the most common thyroid malignant tumor, is from thyroid epithelial cells of malignant tumor, most of the thyroid cancer originated in follicular epithelial cells, pathological types can be divided by papillary carcinoma (60%), follicular adenocarcinoma (20%), but the prognosis is good; Follicular adenocarcinoma tumor growth faster, blood of intermediate-grade malignancy, easy to transport transfer; Anaplastic carcinoma prognosis is poor, the average survival time 3 ~ 6 months. Thyroid cancer with papillary carcinoma in clinically relatively rare.

Published by admin on Mar 21, 2011 under Uncategorized | Post your comment now

Colorectal cancer and the diseases easily confused

December 21st, 2010 by admin


Colorectal cancer should with some other with abdominal mass, cramping, rectal bleeding or stool habits change wait for a symptom of intestinal disease, including colon disguised identify the benign tumor or polyps to produce lesions as adenoma, inflammatory polyp, youth sex polyp, wiggle lipoma, hemangioma, leiomyoma etc;  E. various inflammatory diseases such as ulcerative colitis, Crobn Addison’s disease, amebic enteritis, Japan schistosomiasis, tuberculosis, colonic diverticulitis, appendicitis surrounding inflammatory bag piece, radioactive enteritis and venereal sex is lymphatic granulation is swollen, benign rectum and canal diseases such as hemorrhoids, anal fissure, anal, etc. Other such as intussusception and sigmoid colon dung block product storage and rare bowel endometriosis also belong to identify list. Due to the large intestine cancer symptom does not special, and intestinal tract diseases clinical manifestations phase overlap, therefore, in clinical diagnosis of many take initiative diagnosis way, eliminate diagnosis with less, suspected patients, ask for details of the history after a careful check, cooperate with fiber colon or X-ray BeiCan enema and pathologic biopsy often can make clear diagnosis. Colon cancer should be mainly with colonic inflammatory disease identification, including Crohn disease, tuberculosis, ulcerative colitis, schistosomiasis granulation is swollen, amebic granulomatous disease etc. In addition, still should with primary liver cancer, biliary disease, appendix abscess photograph differentiate. Colorectal cancer should with the bacterium dysentery, amebic dysentery, hemorrhoids, schistosomiasis, chronic knot photograph differentiate.

 1. Shigellosis is main with chronic bacterial dysentery identification. Patients have abdominal pain, diarrhea, tenesmus, mucous symptom such as purulent blood, and defecate number increase, left lower quadrant abdominal tenderness as characteristics. As for chronic bacterial dysentery, can have acute onset, divide afore-mentioned semiotic aggravate outside still fever, headache, loss of appetite. This disease has the epidemiological characteristics, defecate cultivate dysentery bacillus positive. Sigmoidoscopy check bowel mucosa except hyperemia, edema, mucosa ulcer outside a granular, can have a scar and bowel mucous polyps, take purulent make germiculture positive high application celiac trane, norfloxacin, levofloxacin antimicrobial treatment such as effective.

 2) amebic dysentery patients present abdominal distension, abdominal pain, diarrhea or tenesmus, bowel movements are mucous take the symptom such as purulent blood, defecate. Chronic type person can have angular, anemia, colon often CuHou can touch, control two ventral and epigastrium often tenderness, easy and colorectal cancer or confused colon cancer. But when this shit has a foul amoebic dysentery, dung can find amebic cyst or nourishing body. Sigmoidoscopy checks to see normal mucosa has typical scattered in ulcer, ulcer bottom scrape take from the materials can be found protozoon anti-bma.

 3. Hemorrhoid clinical admiral colorectal misdiagnosed as hemorrhoids. See the real many According to the Shanghai tumor hospital statistics 590 cases of colorectal cancer misdiagnosed hemorrhoid person in 156, the misdiagnosis rate up to 26.4%. The main causes of misdiagnosis system of history didn’t know, but not be refers to check. General hemorrhoids more for painless bleeding, a bright red, not with defecate mixed with the amount of blood loss and expression is defecate surface and the blood, blood, linear bleeding even injection shape bleeding. And colorectal cancer patients of feces often accompanied by mucus and rectal stimulating symptoms, digital rectal examination or sigmoidoscopy examination can identify with colorectal cancer will hemorrhoids.

 4. With tuberculosis of tuberculosis of the right lower abdominal pain, diarrhea, paste sample, and abdomen bag piece and systemic tuberculosis poisoning symptoms as feature. Hyperplasia with constipation, type of tuberculosis of as the main performance. X-ray gastrointestinal barium meal can identify with colorectal cancer. Ulcer type of tuberculosis of the intestines, barium in lesions 39% visible signs of filling, not beautiful, but in the upper section of barium bowel lesions is filled with good, called X line barium shadow jumping pine. Mucosal ZhouBi coarse disorderly, bowel wall edge is irregular, sometimes indented. Hyperplasia type of tuberculosis of the intestines period saw proliferative narrow, shrink and deformation, visible filling defect, mucous membrane ZhouBi disorder, wiggle stifness and colon bag disappear. As for fiber colonoscopy, from the lesion site biopsied may attain the farther diagnose.

 5. Schistosomiasis schistosomiasis bowel lesions in descending colon, rectum and sigmoid colon and worm eggs deposition in bowel mucosa made local congestion, edema, necrosis, when necrosis after falling off is formed namely superficial mucosal ulceration, clinically, abdominal pain, diarrhea and stool, further appear the symptom such as connective tissue hyperplasia, and finally make bowel wall thickening, serious cause fluctuate a narrow and granuloma, should distinguish with colorectal cancer. But Japan schistosomiasis colon cancer and have certain mutual relationship, therefore, should be in colonoscopy in the lesion site, especially for granulomatous lesion biopsy.

 6. Crohn’s disease crohn’s disease for granulomatous inflammatory lesions, concurrent fibrous change and ulcers, good hair in young and middle-aged. Diarrhea general light, every defecate 3 ~ 6 times, abdominal pain more in the right lower quadrant abdominal, after defecate abdominal pain can reduce, about 1/3 cases in the right lower quadrant abdominal can ammonites and bag piece, and can appear anal, anus around abscess. Barium enema have characteristics change, visible bowel wall thickening, stiff neck narrow, mucous membrane, ZhouBi disappear, coarsens, flat, straightened, is a thin strip shadow, Longitudinal form sores and transversely fissure shape ulcer; Normal mucosa is congestion, edema, fibrosis, submit false polypoid lesion called pebble duty. Fiber colon visible mucosa edema, slightly hyperaemia, pebbles, accompanied by circle, sample uplift linear or groove, trelleborg sample ulcers. The patient often concurrent fever, anemia, arthritis and liver disease.

 7. Ulcerative colitis UC is a reason unknown rectum and colon chronic inflammatory disease, 95% cases have rectal involvement. In the 20 ~ 50 more see. To clinical symptom such as purulent blood and diarrhea, mucous, abdominal pain and tenesmus as the main performance, so easily confused with colorectal cancer. Fiber colonoscopy visible lesions mucosa is diffuse hyperemia, edema, the mucosal surface in a granular, debaucjed, often have small ulcers or shallow, accompanied by mucus and purulent, the person that weigh ulcer is bigger. Later, colon polyps visible pseudo bag disappear. Gas barium double contrast imaging visible mucosa ZhouBi bulky disorder, ulceration and secretion cover, bowel wall edge can show burr form or jagged, narrow neck stiff, later intestines, colon bag disappear, formation of polyps pseudo after a round or pebble form filling defect.

 8. Irritable bowel syndrome IBS is a kind of intestinal function disorder, its occurrence and mental factors. Abdominal pain, diarrhea, constipation and diarrhoea and constipation alternately, indigestion, as its main performance. But generally good conditions, many dung conventional and cultivation of X line barium are negative, irrigation and fiber colonoscopy are of no positive discoveries.

 

Published by admin on Dec 21, 2010 under Uncategorized | Post your comment now

What diseases can be complicated by nasopharyngeal

December 18th, 2010 by admin


Nasopharyngeal carcinoma is mainly manifested in the complications of cranial bible and tumor swollen peripheral vascular invasion of, and the emergence of the corresponding clinical manifestations. Vision changes, nose pharynx ruptured vessel hemorrhage, these often also is the common signs nasopharyngeal carcinoma.

 

Published by admin on Dec 18, 2010 under Uncategorized | Post your comment now

What should be done check nasopharyngeal

December 18th, 2010 by admin


(a) before the nostril endoscopy nasal mucosa convergence, premenstrual nostril lens can peep of nose pharynx ministry, after nostril and intrusive or adjacent nostril can find the cancer is swollen.

 (2) indirect nasal pharyngoscopy screening method is simple and practical. Should check the nose and throat in turn each wall, pay attention to the nose pharynx top rear wall on both sides and pharynx fossae, want on both sides of the corresponding parts controlled observations, all sides of asymmetric submucosal uplift or isolation nodules more attention should be.

 (3) fiber nasal pharyngoscopy screening for fiber nasal pharyngoscopy screening can use first 1% ephedrine solution convergence nasal membrane expansion nasal path. Reoccupy 1% to lignocaine solution surface anesthesia nasal way, then will fiberscopes from nasal insert, side observation, side forward, until nose pharynx cavity. This method is simple, mirror fixed, but after nostril and top front wall observation is not satisfied.

 (4) to the already nose pharynx neck biopsy cases of failed to diagnose biopsy can be conducted neck lump biopsy. Generally, are available on under local anesthesia, preoperative when should choose appears the earliest hard for even the whole lymph nodes, pick out coated. Such as excision biopsy has difficulty, can be in mass where wedge cut take biopsy, cut take organization must have certain depth, and avoid by all means is squeezed. Intraoperative when operative field is unfavorable be Picasso tight overcrowded suture.

 Histopathological examination in have bump place or suspected tumor area bite take organization, inoled lymph nodes should also take out for pathological diagnosis. Squamous cell carcinoma cell bodies, intercellular Bridges visible, reason cell borders. Cytoplasmic much, eosinophilic, part of Angle, Nuclear obvious, hyperchromatic nuclei and abnormity sex big, fission is visible. In the center of the nests of cells, form Angle of Angle bead. According to the degree of Angle or Angle of bead much and intercellular Bridges quantity can be squamous cell carcinoma is divided into high, middle, and low differentiated 3 kinds. Nasopharyngeal squamous cell carcinoma, oropharynx, special type for lymphatic epithelial tumor (lymphoepithelioma), poorly differentiated, even in primary focal before may have infringed orbit, happen lymph node metastases. Sometimes primary focal small, positioning biopsy difficulties, most blindly biopsy may reveal primary cooker. A third of the patients with a certain degree of skull base damage, most brain nerve damage, first for exhibition nerve damage, after other nerve paralysis. Lymphatic epithelial tumor and divided into two subtypes:

 (1) Regaud type: larger cells, poorly differentiated, a round or oval, nuclear fission vacuolated, more than in the cancer cells of the cable or trabecular shape distribution in rich lymphoid stroma.

 (2) Schmincke type: similar to the reticular cell degeneration of cancer cells, a small nest or round state decentralized in lymphoid stroma.

 The two type of lack of Angle, so the diagnosis is difficult. But the electron microscope has seen the cytoplasm; filaments and intercellular Bridges grain connection, verifiable Keratin dyeing positive from epithelium.

 (5) fine needle aspiration biopsy suction this is a simple and easy, safe and effective tumor diagnostic methods, in recent years was relatively push. For who is suspected cervical lymph node metastases may be the first to use cytologically obtain cells. Specific methods are as follows:

 1. The nose pharynx mass biopsy: use 7 long needle connected into syringes. The mouth &fauces after anesthesia in indirect nose pharynx microscopically will needle pierced tumor essence inside, extraction of syringe make into negative pressure, can be in tumor within round-trip activities twice, will extract coating on the slides do cytology.

 2. Neck lump of fine needle aspiration biopsy: use 7 or 9 10m1 syringe needle connected into. Local skin after disinfection, choose puncture point, along the long axis direction needle into the tumor, suction syringe and make needle in mass round-trip activities within 2 ~ 3 times, remove and will suction things do cytology or pathological examination.

 (6) EB virus identified serologically currently universally applied in immune enzymatic detection EB virus IgA/VCA and IgA/EA antibody drops degrees. The former is highly sensitive, accuracy, low, While the latter just contrary to that. So the suspect and the appropriate nasopharyngeal carcinoma simultaneously two antibodies detection, which in the early diagnosis helpful. VCA drops of IgA/degree p came and/or IgA/EA drops degrees cases of abia p, even of nose pharynx ministry, also should not seen anomalies in nasopharyngeal carcinoma sigmoidal take exfoliated cells or live biopsy. Such as temporary still undiagnosed, should be regular follow-up, when necessary for multiple biopsies.

 (7) nose pharynx side a slice, skull base of films and CT examination of each patient shall be nose pharynx side a conventional photos and pictures skull base. Yi and sinuses, the middle ear or other parts have the offenders shall be correspondingly radiography examination. Conditional unit should be a CT scan understand local expansion and specifically requires mastery is beside the invasion of the scope of tubal clearance. This to determine the clinical stages and establishing treatment options are very important. Nose pharynx side a piece, peaked back wall of the soft tissue diffuses thickening or local outstanding. A piece, if the skull base of bone violation, see edge irregular dissolve bony defect or duct expansion. CT scan the resolution is high, can clearly shows that the soft tissue mass density of shadow and bone destruction area, nose pharynx beside each clearance lesions range (figure 3). Eye socket, each sinuses, wing palatal nest and cavernous sinus involvement (figure 4). CT examination to radiation therapy, design, operation mode option and follow-up is of great significance, should be taken as a routine scan.

 

 

 

 

 

 

 (8) type B ultrasound type B ultrasound in the diagnosis and treatment of nasopharyngeal carcinoma (NPC) has been widely used method is simple, and no damage sex, the patient willing to accept. In nasopharyngeal carcinoma is mainly used in the liver, neck, retroperitoneal and pelvic lymph nodes of check, understand without lier metastasis and lymph nodes density, presence of cystic etc.

 (9) magnetic resonance imaging examination because of magnetic resonance imaging (MRl) can clearly show head all levels, brain ditch, gyrus, gray, white matter and ventricle, cerebrospinal fluid piping, blood vessels, etc, with SE law shows T1, T2 extended high strength image can be diagnosed nose pharynx, the frontal sinus tumor, and shows that the tumor with the surrounding tissue relationship.

 For EB virus associated antibody examination can understand disease occurrence and development situation.

 

Published by admin on Dec 18, 2010 under Uncategorized | Post your comment now

Endometrial cancer and the diseases easily confused

December 15th, 2010 by admin


The disease with the following disease must distinguish:

  A postmenopausal bleeding first should be wary about whether for malignant tumor, despite the progress, with postmenopausal bleeding in the proportion of malignant tumor has dramatically reduced.   If such reports, Knitis 1940s postmenopausal vaginal bleeding in malignant diseases account for 60 ~ 80%, 1970s lung to 25 ~ 40, in the 1980s and reduced to 6 ~ 7%.  Domestic Sue should wide report, in the 1960s, 76.2% malignant disease of endometrial carcinoma accounts for malignant disease 12.9%. Eighties, yellow lotus feng etc, malignant disease reported, and endometrial carcinoma of 22.7% accounted for malignant cases were 45.5%, cervical cancer accounts for a 43.6% stake. ZhengYing such reports, malignant diseases account for 24.9% (benign 73.3%), ranking postmenopausal bleeding second place. From duration ofmenopause look, menopause 5 years 14% menopause 5 ~ 15 years may make 68.3%. Visible, in malignant tumor with the progress, endometrial carcinoma is rising trend. Yellow lotus feng reports even more than the cerical cancer. Postmenopausal bleeding and cancerous degree does not necessarily become direct ratio. The bleeding can seldom, bleeding number are also few that cancer change may have more apparent. So carefully do gynaecological check-up, found out the vagina, cervical, uterine body, attachment or abnormal situation exists. Because there may be two or more lesions also exists, if there are senile vaginitis, also have endometrial cancer, so never have found a kind of pathological changes and ignore the further examination. Except cytology outside, segmentation domain-specific scrape is indispensable inspecting steps, because of curettage due technique the endometrial cancer diagnose rate is as high as 95%. Domestic ChengWeiYa reports, 10 years 448 cases of domain-specific postmenopausal uterus bleeding, including scrape endometrial endometrial carcinoma accounts for 11.4% (51 cases), LuoQiDong etc is 8.7 percent reported. Reports in the literature for 1.7 ~ 46.6% differ, normally in 15% below.

 Second, uterine bleeding menopause lost tonal functions often happens menstrual disorders, especially the uterine bleeding more frequent, no matter whether normal uterus size, must first do domain-specific blow, clear nature again after treatment. Endometrial cancer can be born to women in the early stages and even fertility. Shandong made the hospital had different endometrial carcinoma patients, only 26-year-old, period overmuch 3 years, according to the dysfunctional uterine bleeding therapies, finally domain-specific scrape confirmed as endometrial carcinoma. So young women uterine irregular bleeding treatment 2 ~ 3 months is invalid, who also should undertake diagnostic. Scraping discern

 Three, endometrial atypical in reproductive age women. Endometriosis dysplasia severe in the organization forms, sometimes difficult well-differentiated adenocarcinomas identification. Usually endometriosis dysplasia, pathology may manifest as focal, have squashed normal epithelial cell differentiation, is good, or visible squamous metaplasia, fat pulp dye lotus design and color, without necrosis infiltrating etc performance. And endometrial adenocarcinoma of cancer cells nuclear chromatin increased, big hyperchromatic, cell differentiation is bad, fission, less cytoplasm, often occur necrosis and infiltrating phenomenon. But with well-differentiated early endometrial adenocarcinoma identification:

 1 not typical increase the living often have complete surface epithelial and adenocarcinoma are not, therefore, such as seen relatively complete or squashed surface epithelial may exclude endometrial adenocarcinoma. In addition, endometrial adenocarcinoma often necrotic bleeding phenomenon;

 (2) drug treatment reaction is different, atypical increase the living, and the dosage slants small namely work slowly, persistent long, once the withdrawal may soon recurred,

 (3) age: young men consider atypical, challenger endometrial adenocarcinoma who consider the possibility.

 Four, submucosal uterine osteoma or endometrial polyps much performance period overmuch or menstrual extension, or hemorrhage also may be accompanied by drainage or bloody vaginal secretions, clinical manifestations and endometrial carcinomas are very similar. But through the exploration, segmentation GuaGong, uterine uterine iodine oil angiogram, or hysteroscopy examination can make the differential diagnosis.

 Five, the cervix with endometrial carcinoma duct carcinoma is same, also performed irregular vaginal bleeding and drainage increase. If pathological examination for squamous cell carcinomas are considering from the cervix. As for adenocarcinoma is identified source can be difficult, if you can find the mucus glands, the primary at neck tube probability. Japan Okudaira etc points out, in cervical adenocarcinoma of invasive carcinoma tissues, the embryo antigen (CEA) positive expression rate is very high, therefore, make the CEA immunohistologic dyeing, conduce to the cervical adenocarcinoma with intrauterine membrane identification.

 Six, primary oviduct carcinoma vaginal drainage, vaginal bleeding and next bellyacke, vaginal smears may find cancer cells and endometrial carcinoma is similar. And tubal carcinoma intrauterine membrane biopsy negatie, palace of mass, and beside can be different from endometrial carcinoma. Such as bag piece small and touch not set a person, can through laparoscopic diagnosis.

 Seven, senile endometritis merger of uterine accumulate pus often presents with vaginal discharge pus, hemorrhagic or the symptom such as purulent blood sex drainage, uterus more increase softened. Through B up check then expansion palace cancerous tissue, see inflammatory infiltrate organization. Pyometra often and cervix duct carcinoma or endometrium coexist, identification, we must pay special attention to.

 Eight, senile vaginitis, mainly for hemorrhagic leucorrhea, when the examination visible vaginal mucosa thinning, congestion or bleeder and secretion of performance, such as increased after treatment can be improved and, when necessary, first as anti-inflammatory treatment for again after of curettage due to exclude endometrial carcinoma.

 Nine, submucous myoma of uterus or endometrial polyps have period overmuch or menstrual extension symptoms, feasible type B ultrasound diagnostic hysteroscopy and subsection, scraping confirm the diagnosis.

 Postmenopausal and menopausal transition vaginal bleeding for endometrial carcinoma of the most common symptoms, reason endometrial carcinoma should with vaginal bleeding all kinds of diseases caused by differential. Gynaecological check-up should eliminate vulvae, vaginal bleeding, cervical and damage such as infection by the bleeding and drainage. Should pay attention to the uterus size, shape, mobility, quality of a material soft, cervix, palace tissue adjacent hardness of accessories for changes, without bag piece and thickening etc all be careful thorough examination.

 

Published by admin on Dec 15, 2010 under Uncategorized | Post your comment now

Ovarian cancer and the diseases easily confused

December 14th, 2010 by admin


1, ovarian cyst if not supenllus naturally follicular cyst, lutein cyst, general diameter less than 5cm, wall thin, more within 1 ~ 2 months decline naturally.

  2, uterine fibroids ovarian tumors may and uterine myoma cystic changes or subserosal next uterine fibroids confusion.  B ultrasonic examination can clear diagnosis.

 3, pregnancies the uterus increases become soft, has menopause history, can diagnose hCG is increasing. B super saw a embryo sacs or TaiXin bo move.

 4, chronic urinary retention many voiding difficulties or urine ungodliness history, bag piece in a ventral midline, boundary is not clear, after catheterization bag piece will disappeared, and also can use B ultrasonic examination identification.

 5, annex inflammatory mass has the chronic pelvic inflammation and sterility history, bag piece lower position, tenderness, and uterine have adhesion.

 6, ascites with tuberculous peritonitis (encapsulated effusion) with huge ovarian cyst identification.

 Huge ovarian cyst, ascites, tuberculous peritonitis (encapsulated effusion) in the differential diagnosis

 Ovarian cyst abdomen water tuberculous peritonitis

 Disease history consciously have bump since ventral side began to increase gradually without bump, secondary to the liver and kidney, heart disease, abdominal organs, angular, thermal gradually swollen enteron symptom obvious, often amenorrhoea, abdomen gradually grand of

 Look at both sides mini-telescope protuberant, abdominal forward a relatively flat side protruding, among a relatively flat, such as frog abdomen uncertain

 Touch diagnosis can feel bump, huge cyst is not easy qing touch of mass have flour-rubbing feeling or have an irregular block

 Knock on both sides of the drum sound, middle mini-telescope voiced consonant without mobility, both sides real sound, intermediate drum sound, has voiced consonant with drum sound mobility boundaries between

 Gynaecological check-up uterus was top forward, not activities, after can be of iterated vault and bursa wall uterine have float ball uterine attachment can be normal, also can with excellent adhesion and touched not pure

 Type B ultrasonic

 Image circle, the boundary of the dark areas liquid neatly, smooth irregular liquid dark areas, including sexual intestinal light floating irregular cystic liquid sex dark areas, wall is often dilated bowel light group organization

 X-ray gastrointestinal

 Angiography gastrointestinal was umbilical outward dilated bowel floating above, mobility, without the placeholder dilated bowel adhesion not easily push lesions

 

Published by admin on Dec 14, 2010 under Uncategorized | Post your comment now

Easy to be confused with the diseases of colon cancer

December 13th, 2010 by admin


Clinical identify points is illness during the period of length, feces detected parasite, barium enema the lesions form and range, etc. One of the most reliable by colonoscopy is still taking biopsy.

1. Idiopathic ulcerative colitis 15% of cases of misdiagnosis. Colon cancer, especially left colonic papillary carcinoma or cauliflower shape carcinoma, illness development to certain degree, often can appear diarrhea, mucous, and then the symptom such as purulent blood, defecate number increase, abdominal distension, abdominal pain, angular, anemia, with symptoms such as fever infected passable etc, these are all poisoning symptoms with idiopathic ulcerative colitis symptoms similar. X-ray, both have similar place. So in clinically misdiagnosed will easily cause, especially for the young patients, less thought of tumor existence.

2. Appendicitis cases of misdiagnosis of 10%. Back to blind department carcinoma is often caused by local pain or tenderness and diagnosed appendicitis. Especially late return blind department carcinoma, local happen often necrotic decay and infection, clinical manifestation has increased body temperature, increased WBC count, the local tenderness or touching bump, often diagnosed as appendix abscess, but adopt conservative treatment. After a period of time to treatment, bump disappear size, and even the increase, just considering the tumor. General appendix abscess earnestly ask medical history have acute onset of the disease process, has inflammation performance, in short-term treatment after observing often can be improved obviously. If the caner and appendicitis coexist or because cancer to appendix obstruction caused appendicitis, although treatment improved, but not completely, after withdrawal shall continue to accentuate further inspection of diagnosis. At the height of the doubt shall promptly surgical incision.

3. Tuberculosis of tuberculosis in our country is more familiar, its sigmoidal terminal ileum, caecum and in the ascending colon. The most common clinical symptoms include abdominal pain, abdomen block, diarrhea, constipation appear alternately in colon cancer patients, it is also more see. Especially hyperplastic tuberculosis with colonic cancer has many similarities, such as a low-calorie, anaemic, angular, lack of power, local can ammonites bump, etc. But the systemic symptom of tuberculosis of the more obvious, performance for the afternoon low heat or irregular fever, night sweats, angular fatigue. Therefore, when clinically appear these symptoms, particularly by diarrhea symptoms and clinically headed mini-telescope often easily from common disease, frequently-occurring disease Angle consideration, the first thought of tuberculosis. Approximately 1% of patients in preoperative misdiagnosis of tuberculosis of the colon cancer will be. Check blood picture but have special change, XieChen fast, tuberculin experiment is strong positive. Combining with the history, age and systemic expression can be generally clear diagnosis.

4. Colon polyps colon polyps are common benign tumor, occurs mostly in the sigmoid colon, its main symptom is stool, blood for blood, not with excrement confusion, some patients may also have the symptom such as purulent blood sample stools. X-rays are performing for filling defect. If you don’t do fiber colon biopsy pathologic examination, may interest RouYang colon misdiagnosed as colonic polyps. Adenomas and colon polyps is the most common benign tumors and tumors sample lesions, both histologically has the obvious difference: adenomatous polyps can produce canceration more does not transform for cancer. Both of these can be single or multiple. In X-ray gas barium dual imaging, a smooth edges sharp circle or elliptic filling defect fluctuate inside, if have pedicle can move, colon outline is changed, adenomas or polyps periphery is like a small when near barium can form one ring shadows, and gas form bright contrast. Do fiber colonoscopy and to take live sends the pathological examination is the most effective identification methods.

5. Schistosomiasis granuloma in popular areas, in southern China see more, with schistosomiasis prevention and control work after liberation, the launch of the current already scarce. Im schistosomiasis is schistosomiasis eggs in bowel mucosa, early next sedimentary relativety large chronic inflammatory granuloma. Late colon fibre hyperplasia, with the surrounding tissue adhesion formation inflammatory mass, colonic mucosa constantly forming ulcer and scar. Because ulcer repair tissue hyperplsia, can form polypoid. A few cases can be cancerous, in popular areas colon cancer also have bowel schistosomiasis were accounted for 48.3% ~ 73.9%), explain schistosomiasis has close relationship with colon cancer. So in popular areas or once lived in popular areas of intestinal schistosomiasis, always has clearly diagnosed patients, more necessary row in the colon or itself without concomitant cancers. Except do x-rays and fiber colonoscopy and biopsy outside, combining history, dejection of schistosoma infection worm, all help check of colon cancer and schistosomiasis caused by intestinal cancerous identification.

6. Amebic granuloma in amebic granuloma formation according to its place colon, the position at abdomen corresponding place can reach bump or obstruction of symptoms. Do merthiolate-iodine-formaldehyde when can find amebic nourishing body and cyst, X-ray 30% ~ 40% of patients may have a positive found that have polyps hyperplasia mucous membrane. Amebic granuloma in loops for multiple, often produce huge unilateral edge defect or circular cut the scent.

Published by admin on Dec 13, 2010 under Uncategorized | Post your comment now

Prostate cancer and the diseases easily confused

December 12th, 2010 by admin


Prostate cancer is one of the malignant disease, should inchoate discovery, inchoate cure, therefore must distinguish with some disease, in order to make clear diagnosis.

(1) should with hyperplasia of prostate disease that differentiates: both general easily identified. But in hyperplasia of prostate gland, some of the regional epithelial cells form not typical, can be mistaken for cancer. Distinguish anubis: hyperplasia glands in gland bubble is larger, the surrounding collagen fiber layer intact, double tall columnar epithelial for prostate cancer patients, the nucleus is small, and occupies cells basal parts, glandular arrangement rules, form apparent nodules.

(2) and prostatic atrophy photograph differentiate: prostate cancer often begins gland atrophy department, should pay attention to identify. Acinar atrophy closely together, sometimes atrophy decrescent, epithelial cells for made square, nuclear big, very like cancerous. But this kind of atrophic changes involving the entire lobules, more collagen connective tissue layers still whole, matrix is inviolable in itself, but is sclerosing atrophy.

(3) and prostatic squamous metaplasia of or transitions that differentiates: often occur in glands of healing, department within infarction squamous epithelial or transitions well-differentiated, no degeneration or split phase. The most prominent feature is im avascular necrosis or lack of smooth muscle fibrous connective tissue stroma.

(4) cases of granulomatous prostatitis: cellular big, can gather into flake. With transparent or reddish staining cytoplasm and small esicular nuclei, very like prostate cancer, but actually macrophages. Another type of cell were pleomorphism, become pyknotic nuclei, show vacuolated, small volume, rows or clusters arrangement, sometimes visible some gland bubble. Identify should pay attention to the cases of granulomatous prostatitis of acinar formation is very few, in lesions and normal gland relationship without change, often is seen degeneration of amyloid body and multinucleated giant cells. And prostate cancer cells are low columnar or set square, have a clear cell wall, dense eosinophilic cytoplasm, nuclear than normal big, dyeing and form can have variation, separation is active. Its acinar lesser, lack of curved tube, normal arrangement form complete loss of irregular to matrix infiltrates, and collagen connective tissue layer already does not exist. Gland bubble inside contain a few secretion, but few have amyloid body. Prostate cancer in case of apparent degeneration, the organization structure disappear completely, no acinar formation tendencies.

Published by admin on Dec 12, 2010 under Uncategorized | Post your comment now

Esophageal cancer treatment

October 9th, 2010 by admin


Surgical treatment:
Esophageal cancer treatment including surgery, radiation and surgery plus radiation therapy and drug treatment or drugs. To improve the treatment effect of the esophagus, most key measures in early diagnosis and early treatment, esophageal cancer treatment options to according to the history, the lesion site, tumor extended range and the whole body condition to decide.
1 in the surgical treatment of esophageal cancer surgery has more than 40 years of history. Since the founding of new China, the surgical treatment of the popularization and has made great improvement. At present, the general patients approximately 80% ~ 85% tupkp operative mortality, below 5%.
(1) the indications and contraindication:
(1) the surgical indications: esophageal cancer diagnosis has been established, the scope limited (5-6cm, no distant metastases, no operative taboo certificate should first consider surgery. Including:
The A.U ICC staging a â…  0, â…¡, â…¡, b and â…¢ T3N1M0 in.
B. radiotherapy fails to control or no local recurrence cases, the obvious signs or distant metastasis.
C. age generally not more than 70 years old, at the age of 80 years, nearly a few cases of smaller biological age but also can be careful consideration.
D. disease treatment and prognosis length is known not closely linked, so when the patient is only choose a reference index.
(2) surgery contraindication are:
An evil disease.
B.I â…¢ late stages of CC (T4 any NM0) and â…£ period.
C. other body system function obstacle, obviously cannot tolerate surgery and anesthesia. Vital organs have serious complications, such as heart disease and lung function with heart failure, or within half a year of myocardial infarction, etc.
(2) the possibility of excision surgery for every preparation judgment: the cases, performer in the possibility of excision preoperatively to judge, judgement basis:
1 parts: the disease is the lowest, tupkp 66.7% ~ 89.5%, In the middle, 79.1% ~ 94.5 percent for the next, Under section and 87.2 98.4% ~.
2 for lesions on direction: if the esophagus with normal section does not agree, and distorted, tumor size, the existing or big transfer nodes to push, excision of possibility.
3 for KanYing ulcer disease such as the position and depth: located in the middle of the esophagus ulcer, or its depth has beyond the wall boundary, means eating the tumor has, or is in primary lung and bronchus or perforation into the aorta, resection (especially the radical excision) are less likely.
4 have in common: soft shadow of X line made movies or CT appears big soft tissue mass pushed tracheal or bronchial, pericardiac or around the aorta more than one in four laps, excision of possibility.
5 if the patient: pain symptoms appear more acuteness breast lesions in the back, means and has been in such a sensitive visceral pleura mediastinum, excision might not.
(3) type:
(1) the radical resection and esophageal revascularization esophageal cancer is limited, can esophagus: pseudoaneurysm resection and draining node to obtain complete resection of esophageal cancer, can regard radical surgery. Due to the esophagus has multiple submucosal primary and spread of biological characteristics, the top of cutting edge resection is insufficient length, postoperative residual cancerous cells can happen anastomotic recurrence. So some Suggestions of all esophageal squamous cell carcinoma with subtotal resection of the esophagus should, if possible, from tumor resection margin should 10cm. Often the esophageal tumor resection, should as far as possible fat surrounding tissue. Radical surgery should include regional lymph node removal. In early esophageal respectively, can open the neck, chest abdominal incisions do esophageal blunt dissection in the neck, to execute BaTuo esophageal stomach stapling. For the whole situation, poor old and frail, cardiopulmonary function is not complete, cannot tolerate thoracotomies for, and cervical anastomosis once occurred fistula, infection easily confined polluting the chest.
2 palliative surgery already belonged to late: esophageal around and have a tight gelling organs or lymph node metastasis, although pseudoaneurysm wide excision, but can be seen and often cannot complete resection of the lymph node metastasis. Not the radical surgery and has high difficulty swallowing, to solve the problem, can eat to local excision, radiotherapy and chemotherapy to provide conditions. If the tumor resection, has not only can reduce shape, have surgery esophageal shunt or lumenal built-in pipe, with temporary solution, then eat of patients with radiotherapy or chemotherapy. Stomach made in patients without much fistula, use less as far as possible.
A. esophageal shunt: in the open-chest surgery exploration, it was found that the tumor resection, if the patient can have serious difficulties, available within the thoracic hypopharyngeal esophageal shunt. According to the primary parts, in the aortic arch upward cancer stomach esophagus anastomosis bow or under. In the above method more consistent longitudinal incision tumor 2cm place with stomach esophagus anastomosis as side. If the esophagus cancer resection, middle estimate possibility, but there are serious difficulty swallowing, with open thoracic colon and esophageal shunt. Using abdominal incisions, before the sternum colon transplantation in the neck after sternal subcutaneous or make colon and incision stomach esophagus anastomosis.
B. lumenal built-in pipe: general condition is poor, not suitable for patients with open thoracic estimate unresectable or unresectable esophageal cancer patient, can proper length and proper thickness of plastic or rubber, the expansion will leave at esophagus tube stenosis, to alleviate temporarily difficulty swallowing or aspiration. Commonly used in the pipeline funnel shaped thicker, placed above narrow, lower case, through the narrow. The method of oral push, through the esophagus mirror catheter, its main shortcoming is expanding esophageal may occur esophageal perforation. Another method is to be guided by stomach esophagus mirror, the stomach wall to drag before incision seeker catheter tube, the advantage is not reliable, complications, such as the esophageal perforation. Thoracotomy (excision of esophageal cancer can detect cannot choledochotomy transesophageal insert.

Published by admin on Oct 9, 2010 under Uncategorized | Post your comment now

Treatment of primary liver cancer Precautions

October 8th, 2010 by admin


(a) therapy

Early treatment of HCC prognosis is to improve the main factor. Early hepatocellular carcinoma should try to take surgically. The liver resection of also can adopt the combined treatment.

Primary liver cancer treatment with radical excision curative effect. The liver resection for not by surgery or nonoperative therapy, make comprehensive after tumor resection 2 or 2 steps, or to slow tumor development, prolong surial purpose, Some types of small HCC through various nonsurgical treatment and the local cure purpose, Patients with adanced cannot tolerate various treatment should protect liver, improve the overall situation and symptomatic treatment, in order to reduce pain, improve the quality of life. For surgery, chemotherapy and radiotherapy, traditional Chinese medicine and immune therapy and other support therapy, suit measures to handle etc, from the overall condition of reasonable selection and can achieve the purpose to enhancethe curative effect.

1 the chemical treatment of HCC

(1) systemic chemotherapy: systemic chemotherapy drug therapy is the most basic of hepatocellular carcinoma, and can be used widely used oral, intravenous, intraperitoneal injection, celiac arteriogram or hepatic artery perfusion and various ways to medicine enema.

In order to reduce systemic chemotherapy, improve the side effects of the treatment effect of the liver, and the clinical application of many drugs, the study found singler combination chemotherapy good curative effect and side effects of chemotherapy. Current treatments used chemotherapy drugs have liver fluorouracil (5 – its) and its derivatives, more than the stars (doxorubicin soft and cisplatin (DDP), wire was (MMC), etc.

Fluorouracil (5 – its) is the most common cancer treatment of the digestive system of drugs, it in the body into 5-fluorouracil transferase-mediated deoxyuridine triphosphate-biotin, can restrain thymine nucleotide synthase, blocking uracil deoxidizing nucleotide changes for thymine transferase-mediated deoxyuridine triphosphate-biotin, interference of DNA synthetic biology, mainly for S period. Specificity, But fluorouracil (5) in the body and transformed into 5-fluorouracil and nucleotide, adding RNA interference to the synthesis of protein in each period of other cells also have certain curative effect. With fluorouracil (5) for hepatocellular carcinoma (HCC) and its effects, according to the report, fluorouracil (5) monotherapy and more efficient in cancer patients under 20%, survival for 2 ~ 5 months. Fluorouracil (5 – its) derivatives for fluoridated (furan fluorouracil), since the 1960s, the application of clinical effects for fluorouracil-based found its (5-7-1), 1/4 for fluorouracil-based chemotherapy index (5-2 times), and its treatment of liver cancer can reach more than 30% of efficient and survival period extended, mass decrease, AFP level drops of primary liver cancer, have certain curative effect. Fluorouracil (5 – its) intravenous is generally 10 ~ 12mg/kg), d. (3 ~ 5 days, can be reduced by half, the dosage of intravenous time, total could reach 6 ~ 8g. For FT207 fluoridated (800 ~ 1200mg /), four times d for medicine orally, 15-20mg/kg d.).

More than (soft with adriamycin), a anthracene ring embedded DNA base and closely combined with the DNA in the nucleic acid contains concentrations. Due to its spatial structure change chimeric DNA, RNA and DNA synthesis of DNA dependence, is a kind of cell cycle nonspecific drugs. In more than star (doxorubicin soft anthraquinone) may exist in the electronic reduction of free radicals, highly active, is one of the mechanism to kill cancer. Now think more than soft (doxorubicin) is the most effective treatment of HCC, it is one of the chemotherapy drugs, after enters the body in the highest concentrations within the liver, stay together for a long time, the pharmacokinetics characteristics in the treatment of liver cancer. Clinical application were (ADM) treating liver cancer, generally think it more good curative effect of hepatocellular carcinoma and more efficient and 10% ~ 30% in hepatocellular carcinoma, can make narrow or resolve. More than (soft ADM) treatment the curative effect of HCC has a certain relationship with the region, it is better to Africa and hepatocellular carcinoma. Some reports that more than star (ADM) soft related with HBsAg curative effect is good, HBsAg positive and its mechanism is not clear. More than (soft ADM) significant effects on the toxicity of the heart is more than that of soft, star (doxorubicin) application to have certain restriction, long time application or one-time high-dose therapy, should pay attention to monitor changes in patients with heart, such as found in the course of treatment of congestie heart failure or early signs of 12-lead electrocardiography QRS group members before treatment below 70% of voltage, stop immediately. More than (soft ADM) derivatives were table (table doxorubicin) and more than star (ADM) soft compared with high and low toxic chemotherapy index, the characteristics, especially in the heart, the effects of small toxicity. More than (soft ADM) application cumulant in 550mg/m2, appear more easily, and watch the heart toxic effects were (e) cumulant is in commonly 1000 mg/m2 above will appear the heart of toxicity. Table were (table doxorubicin) and more than star (ADM) soft only for intravenous, single dosage for 60-80 mg/m2, once every three ZhouChongFu. Combination therapy should be reduced.

Wire (MMC) was the actinobacteria are fermented product, can combine covalently connected with the DNA into DNA damage cells, thereby, in order to achieve the cancer structure of cell cycle nonspecific, belong to cancer. The tropics.ophthalmology of liver cancer treatment effect is uncertain. South Africa was reported application tropics.ophthalmology treating liver cancer patient surial, average only 34 days, But reports from Japan, the tropics.ophthalmology (MMC) treating liver cancer can obtain good effect, the patient surial after more than a year, treatment of disease visible necrosis, fibrosis. The tropics.ophthalmology (MMC) intravenous common dose 4 ~ 6mg/times, 2 times a week. Oral 2 ~ 6mg, 1 times/d, 120mg 80 ~ is one period of treatment.

Published by admin on Oct 8, 2010 under Uncategorized | Post your comment now