简介:摘要目的探讨肾错构瘤的临床表现及诊治要点。方法复习文献资料回顾我院经手术及病理检查确诊的45例肾错构瘤患者的诊治情况。结果45例术前均行B超、静脉肾盂造影及CT检查、22例术前行腹主动脉造影检查。22例行患肾切除、11例行肾部分切除、12例行肿瘤剜除术。结论超声、CT、IVU对该瘤有较高的诊断价值。对瘤体大于4cm、肿瘤短期内体积增大症状明显、不能排外肾癌者应积极手术治疗,并尽量保留有功能的肾组织。强调其有恶变的可能,应进行长期随诊。
简介:摘要目的通过对2008年6月至2012年7月间我科收治的45例脑动静脉畸形(cerebralarteriovenousmalformationAVM)患者诊治结果分析,探讨对AVM安全有效的治疗方法。方法按SPETZLER-MARTIN分级法对45例脑AVM患者进行分级,并分析治疗结果。45例患者显微手术26例,其中显微手术后ONYX胶栓塞1例,显微手术后伽玛刀治疗2例;血管内ONXY胶栓塞4例,其中栓塞后显微手术1例;伽玛刀治疗1例;射波刀治疗14例。结果45例脑AVM患者按SPETZLER-MARTIN分级I级10例,II级14例,III级14例,IV级7例。显微手术治疗的26例中术后术区出血死亡2例,其它原因死亡,1例,手术病死率11.5%。20例术后DSA或MRI检查完全AVM消失,2例AVM残留经伽玛刀治疗后病灶消失,1例治疗后失随访。ONYX胶栓塞4例2例AVM消失,2例复发后经伽玛刀治疗后治愈。单纯伽玛刀治疗1例4年后AVM消失。射波刀治疗14例中8例消失,4例缩小,2例无变化仍在随访中。结论根据脑AVM的影像学特征和病人的临床特征,个体化选择显微外科手术切除、血管内ONYX胶栓塞以及立体定向放射治疗,或几种方法联合治疗,对绝大多数AVM可以取得良好效果。位于非功能区显微手术可以全切病灶。极少数(本组2例占全部病例4.44%)体积巨大、位于重要功能区、具有复杂的多支供血和引流的AVM,无法手术或介入治疗,射波刀作为一种新型的立体定向放射手段可供选择,但其远期效果尚需进一步观察和总结。
简介:TcellhomeostasiscommonlyreferstothemaintenanceofrelativelystableTcellnumbersintheperipherallymphoidorgans.AmongthelargenumbersofTcellsintheperiphery,Tcellsexhibitstructuraldiversity,I.e.,theexpressionofadiverserepertoireofTcellreceptors(TCRs),andfunctionaldiversity,I.e.,thepresenceofTcellsatna(I)ve,effector,andmemorydevelopmentalstages.AlthoughthehomeostasisofTcellnumbershasbeenextensivelystudied,investigationofthemechanismsunderlyingthemaintenanceofstructuralandfunctionaldiversityofTcellsisstillatanearlystage.ThefundamentalfeaturethroughoutTcelldevelopmentistheinteractionbetweentheTCRandeitherselforforeignpeptidesinassociationwithMHCmolecules.Inthisreview,wepresentevidenceshowingthathomeostasisofTcellnumberanddiversityismediatedthroughcompetitionforlimitingresources.ThenumberofTcellsismaintainedthroughcompetitionforlimitingcytokines,whereasthediversityofTcellsismaintainedbycompetitionforself-peptide-MHCcomplexes.Inotherwords,diversityoftheself-peptiderepertoirelimitsthestructural(TCR)diversityofaTcellpopulation.Wespeculatethatcognatelowaffinityself-peptides,actingasweakagonistsandantagonists,regulatethehomeostasisofTcelldiversitywhereasnon-cognateornullpeptideswhichareextremelyabundantforanygivenTCR,maycontributetothehomeostasisofTcellnumberbyprovidingsurvivalsignals.Moreover,self-peptidesandcytokinesmayformspecializednichesfortheregulationofTcellhomeostasis.