The diameter of the giant coronary artery aneurysm is at least 4 times bigger than that of the normal coronary artery and 2-3 times bigger than that of the normal coronary artery aneurysm. Giant coronary artery aneurysm is rare in clinic with a reported morbidity which is less than 0.3%. Just like ordinary coronary artery aneurysm, coronary artery atherosclerosis is the main cause of the giant coronary artery aneurysm. Most giant coronary artery aneurysms are asymptomatic, but some patients may have heart-related clinical emergency in short term and may have thrombosis which can lead to embolism and fistula which can cause rupture in long term. Surgical treatment is the first chioce for giant coronary artery aneurysm now. However, the interventional therapy will also be an important way to treat the disease in the future. In this article, we review the diagnosis, clinical manifestation, treatment and other aspects of giant coronary artery aneurysm as follows.
【摘要】 目的 探討子宮頸巨大平滑肌瘤在其診斷及治療上的特殊性。 方法 對2007年10月-2010年3月收治的11例子宮頸巨大平滑肌瘤患者的臨床資料進行分析，對其發病率，診斷和手術治療進行評價。 結果 11例子宮頸巨大平滑肌瘤中黏膜下2例，腹膜后9例。術前9例出現誤診，其中誤診為盆腔包塊5例，子宮體肌瘤3例，子宮肉瘤1例。6例行經腹子宮全切加雙附件切除，2例行經腹子宮切除術，1例行經腹肌瘤挖除術，1例行經陰道肌瘤摘除術，1例行經腹肌瘤挖出加宮頸殘端切除術。 結論 子宮頸巨大平滑肌瘤由于其位置的特殊性，尤其是凸向腹膜后的肌瘤，由于盆腔器官被擠壓，使盆腔解剖結構發生改變，術前易被誤診。且手術過程中易出現損傷及出血，因此術前估計充分，術中仔細認清各器官解剖關系，可有效地減少術中損傷和控制出血。【Abstract】 Objective To investigate the particularity of diagnosis and treatment for giant uterine cervical leiomyoma. Methods We analyzed the clinical data of 11 patients with giant uterine cervical leiomyoma who were admitted in our hospital from October 2007 to March 2010. The incidence, diagnosis and surgical treatment of the disease were evaluated. Results Of the 11 cases, nine were retroperitoneal leiomyoma and two were submucous leiomyoma. There were nine misdiagnosed cases before operation, including five diagnosed as pelvic mass, one as uterine sarcoma and three as uterine corpus leiomyoma. Six patients underwent abdominal hysterectomy and bilateral salpingo-oophorectomy; two underwent abdominal hysterectomy; one underwent abdominal myomectomy; one underwent transvaginal myomectomy; and one underwent abdominal myomectomy with excision of cervical stump. Conclusion The giant uterine cervical leiomyoma is easily misdiagnosed preoperatively due to its special anatomic site. A good example is the retroperitoneal leiomyoma in which the pelvic anatomic structure is changed because of the extrusion of the tumor on other pelvic organs. Furthermore, injuries and bleeding often happen during the operation. Consequently, sufficient preoperative assessment and clearly identifying regional anatomical relations can effectively reduce the damage and bleeding during the operation.
【摘要】 目的 探討CT對嬰幼兒腹部巨大囊性病變的診斷價值及其鑒別診斷。 方法 搜集2003年-2009年間經手術病理證實的2歲以內患兒腹部巨大囊性病變62例，分析其病變部位、大小、形態、分隔、密度和強化、囊壁及與周圍臟器關系等要素。 結果 62例中，先天性膽總管囊腫4例，重度腎積水36例，巨輸尿管2例，囊性腎母細胞瘤4例，大網膜囊腫4例，腸系膜囊腫3例，卵巢囊腫6例，囊性畸胎瘤3例。 各種囊性病變有其一定的發病部位和特征性的CT表現。 結論 CT是嬰幼兒腹部囊性病變定位、定性診斷的重要影像學方法。【Abstract】 Objective To explore the value of CT diagnosis and differential diagnosis of the giant cystic lesions in abdomen of the infants. Methods A total of 62 infants younger than 2 years old with the giant cystic lesions in abdomen confirmed by surgery and histopathology from 2003 to 2009 were collected. The location of the lesion, range, configuration, thickness of cystic wall and septa, density, contrast enhancement, and adjacent organs were observed and analyzed. Results In 62 infants, there were congenital cyst of common bile duct in 4, giant hydronephrosis in 36, primary megaureter in 2, cystic Wilms tumor in 4, greater omentum cyst in 4, mesenteric cyst in 3, ovarian cystic in 6, and cystic teratoma in 3. Each disease had its own lesions location and features of CT images. Conclusion CT is very effective on the localized and qualitative diagnosis of the giant cystic lesions in abdomen of infants.
Objective To investigate the effect of coronary artery bypass grafting (CABG) on patients with coronary heart disease and giant left ventricular dimension but without aneurysm. Methods The clinic data of 51 consecutive patients with coronary heart disease accompanied by enlarged left ventricle dimension without aneurysm, including 50 males and 1 female, undergoing CABG between January 2004 and December 2006 in Nanjing First Hospital of Nanjing Medical University was retrospectively reviewed. The patients were at the age of 54-61 years with an age of 57.5±3.2 years. All patients received CABG, combined with aortic valve replacement in 7, mitral valve replacement in 16, mitral valvoplasty in 17 and tricuspid valvoplasty in 7. After surgery, perioperative complications and mortality were closely observed and followup for a period of 37 months was carried out. Results The number of distal anastomoses per patient was 2.0-4.0(3.8±1.1). Four patients died perioperatively (7.8%), among whom 2 died from malignant ventricular fibrillation, 1 from acute kidney failure and 1 from stroke caused by severe low cardiac output syndrome. All other patients were discharged from hospital with good recovery. After operation, 5 patients had atrial fibrillation and 11 had ventricular fibrillation, but all of those patients survived after proper treatment. The followup period for 47 patients was 37-49 months (43±11months), with a followup rate of 100%. No death occurred during the follow-up. Ultrasound cardiography in the followup period showed that there was a decreased left ventricular enddiastolic dimension (59±2 mm vs. 68±5 mm; t=7.320, Plt;0.05) and an improved left ventricular ejection fraction (45%±17% vs. 34%±15%; t=4.770, Plt;0.05) compared with those before operation with statistical significance. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with giant left ventricular dimension but without aneurysm.
Objective
To evaluate effect of massive and complex incisional hernia or defect of abdominal wall by using prosthetic mesh.
Method
The clinical data of 112 patients with massive and complex incisional hernia or defect of abdominal wall from February 2003 to February 2016 were analyzed retrospectively.
Results
Sixty-three cases were repaired by placing artificial mesh between the peritoneum and the musculus rectus abdominis and 49 cases by opening intraperitoneal mesh placement. The primary healing occurred in 108 cases, the incision infection occured in 4 cases, the seroma occurred in 7 cases. The stretched feeling was found in 39 cases and the mild pain occurred in 17 cases in the operative area at early term after operation. One hundred and two patients were followed up for 9–156 months (mean 78.6 months), the recurrence was observed in 3 cases (2.94%).
Conclusion
Repair of massive and complex incisional hernia or defect of abdominal wall by using prosthetic mesh has some advantages of minimal invasiveness, rapid convalescence, and low recurrent rate.
