RESUMEN

BACKGROUND: The spleen is thought to be central in regulating the immune system, a metabolic asset involved in endocrine function. Overwhelming postsplenectomy infection leads to a mortality rate of up to 50%. However, there is still controversy on performing subtotal splenectomy as treatment of splenomegaly due to portal hypertension in cirrhotic patients. In the present study, immunocytes and the indexes of splenic size, hemodynamics, hematology and immunology in the residual spleen were analyzed to support subtotal splenectomy due to splenomegaly. RESULTS: In residual spleen, T lymphocytes mainly were focal aggregation in the periarterial lymphatic sheath. While B lymphocytes densely distributed in splenic corpuscle. In red pulp, macrophages were equally distributed in the xsplenic cord and adhered to the wall of splenic sinus with high density. The number of unit area T and B lymphocytes of splenic corpuscle and marginal zone as well as macrophages of red pulp were obviously increased in the residual spleen, while the number of macrophages didn't be changed among the three groups in white pulp. While there were some beneficial changes (i.e., Counts of platelet and leucocyte as well as serum proportion of CD3+ T cells, CD4+ T cells, CD8+ T cells were increased markedly; serum levels of M-CSF and GM-CSF were decreased significantly; The proportion of granulocyte, erythrocyte, megakaryocyte in bone marrow were changed obviously; But serum IgA, IgM, IgG, Tuftsin level, there was no significant difference; splenic artery flow volume, portal venous diameter and portal venous flow volume, a significant difference was observed in residual spleen) in the clinical indices. CONCLUSION: After subtotal splenectomy with splenomegaly due to portal hypertension in cirrhotic patients, the number of unit area T and B lymphocytes, and MØ in red pulp of residual spleen increased significantly. However, whether increase of T, B lymphocytes and MØs in residual splenic tissue can enhance the immune function of the spleen, still need further research to confirm.

Asunto(s)

Cirrosis Hepática , Linfocitos , Monocitos , Bazo , Esplenectomía , Esplenomegalia , Adulto , Femenino , Factor Estimulante de Colonias de Granulocitos y Macrófagos/sangre , Factor Estimulante de Colonias de Granulocitos y Macrófagos/inmunología , Humanos , Inmunoglobulinas/sangre , Inmunoglobulinas/inmunología , Recuento de Leucocitos , Cirrosis Hepática/sangre , Cirrosis Hepática/inmunología , Cirrosis Hepática/patología , Cirrosis Hepática/cirugía , Linfocitos/inmunología , Linfocitos/metabolismo , Linfocitos/patología , Factor Estimulante de Colonias de Macrófagos/sangre , Factor Estimulante de Colonias de Macrófagos/inmunología , Masculino , Monocitos/inmunología , Monocitos/metabolismo , Monocitos/patología , Estudios Retrospectivos , Bazo/inmunología , Bazo/metabolismo , Bazo/patología , Bazo/cirugía , Esplenomegalia/sangre , Esplenomegalia/inmunología , Esplenomegalia/patología , Esplenomegalia/cirugía

RESUMEN

Objective To analyze the ultrasonic features of thyroid microcarcinoma (TMC) and the causes of misdiagnosis. Methods The ultrasonic features including shape, margin, echogenecity, microcalcification, vascularity and lymphadenopathy were analyzed retrospectively in 26 pathologically-proven TMC patients. Results In 26 cases, 11 cases were diagnosed correctly before operation (11/26, 42.31%), 12 cases were misdiagnosed (12/26, 46.15%) as adenoma or benign nodule, and 3 cases were missed diagnosed (3/26, 11.54%). Among the 23 cases detected on ultrasound, 21 cases were solid and hypoechoic (21/23, 91.30%);19 cases were ill-defined (19/23, 82.61%);12 cases were taller than wide in shape (12/23, 52.17%); 14 cases had microcalcification (14/23, 60.87%); 7 cases showed central or peripheral blood flow signals (7/23,30.43%) with arterial resistance index>0.70 in 3 lesions and<0.70 in 4 lesions. Conclusions Several ultrasonographic features are helpful in identiifcation of TMC, including hypo/iso-echogenecity, ill-deifned margin, taller-than-wide shape, microcalciifcation, arterial signals with high resistance index, and abnormal lymphadenopathy. Moreover, for cases with multiple lesions, to the potential co-existence of benign and malignant lesions should be considered.

RESUMEN

Objective To explore the surgical skills and efficacy of microsurgical excision of large acoustic neurinoma via the suboccipital retrosigmoid keyhole approach. Methods Fifty-nine patients with large acoustic neurinoma (≥3 cm) underwent microsurgical resection via suboccipital retrosigrmoid keyhole approach. The intraoperative position of the operative bed and angle of the microscope were adjusted to expose the tumors sufficiently. The duramater was sutured tightly and the bone flap was replaced and fixed. Results Of the 59 patients, 53 (89.8%) received a total resection of the tumors, and 6 (10.2%) subtotal resection. No patient died. The facial nerve was anatomically preserved in all the patients. Forty-five patients (76.3%) suffered from mild or moderate facial palsy after the surgery, and the symptoms were improved significantly after expectant treatment. Fifteen patients preserved partial hearing. No subcutaneous water accumulation or cerebrospinal fluid leakage occurred.Conclusion Microsurgery via suboccipital retrosigmoid keyhole approach is a favorable treatment for large acoustic neurinomas with low morbidity and mortality,which can effectively protect the function of the acoustic and facial nerves.