Gestational Trophoblastic Disease Diagnosis and Treatment： An Analysis of 56 Cases

Objective To investigate the diagnosis and treatment of gestational trophoblastic disease （GTD）. Methods A retrospective review was conducted on 56 patients with GTD who under- went treatment in Ruijin hospital from January 2007 to December 2012. Their infor- mation of diagnosis, treatments, follow-up and efficacy were collected and analyzed Results Misdiagnosis rate was 41.1% （23/56）for the first time. Of 56 patients, 31 had direct curettage, 19 had curettage after trichosanthis （TCS） treatment, 3 had curettage after intervention treatment and 3 did not have curettage. Twenty patients with gesta- tional trophoblastic neoplasia （GTN） took fluorouracil＋vincristine＋dactinomycin （VCR ＋KSM＋5-FU） chemotherapy, but 2 of them changed to etoposide＋methotrexate＋acti- nomycetes streptozotocin-D＋cyclophosphamide＋vincristine （EMA-CO） chemo- therapy due to drug resistance. Three patients＂ with GTN took EMA-CO chemotherapy. Two patients with placental site trophoblastic tumor （PSTT） required surgeries, one took hysterectomy, another got mass and adnexectomy. Apart from 1 case who gave up treatment and was dead, all the other women went into remission from their diseases. Conclusion The diagnosis of trophoblastic disease rely on a comprehensive analysis. A reasonable choice of TCS or intervention can be effective and safe in treating GTD. Most patients with GTN could get complete remission by selecting the appropriate chemotherapy and surgery.     

Intracranial Hypertension Syndrome in Systemic Lupus Erythematosus： Clinical Analysis and Review of the Literature

In order to better understand the clinical manifestation of systemic lupus erythematosus （SLE） with intracranial hypertension syndrome （IHS）, we analyzed the clinical features and treatment of a typical SLE patient with IHS. SLE is one of the most unpredictable autoimmune diseases involving multiple organ systems that is defined clinically and associated with antibodies directed against cell nuclei. IHS is an uncommon manifestation of neuropsychiatric SLE （NPSLE） and is characterized by an elevated intracranial pressure, papilledema, and headache with occasional abducens nerve paresis, absence of a space-occupying lesion or ventricular enlargement, and normal cerebrospinal fluid chemical and hematological constituents. IHS has been reported in a few sporadic cases in patients with SLE worldwide, but rarely has been reported in China. In this study, a 34-year-old female SLE patient with IHS was. reported and pertinent literature reviewed. The clinical presentation, image logical features, and investigatory findings were discussed.     

Factors Associated with Coronary Artery Disease in Young Population （Age≤40）： Analysis with 217 Cases

Objective To investigate the relevant factors of coronary artery disease （CAD） in young people under 40 years of age. Methods The study population was 292 young patients accepting coronary angiography in Fuwai Hospital from July to December 2006, including 272 men and 20 women, with the mean age being 36.7±3.7 years. The diagnosis of CAD was made in the cases presenting ~ 50% stenosis in coronary lumen in coronary angiography. Based on the diagnosis, 217 patients （204 men, 13 women） were assigned to CAD group, and 75 （68 men, 7 women） to non-CAD group. Clinical data and metabolic characteristics of the patients were collected and analyzed using t-test, Z2 test, and multinomial logistic regression with SPSS 8.0 software. Results Most study subjects were current smokers （209/292, 71.6%）, and more than half had body mass index （BMI）〉24 kg/m2 （230/292, 78.8%） and usually took high-fat diet （162/292, 55.5%）. The proportion of heavy smokers （smoking history ≥10 years and t〉20 cigarettes per clay） were significantly higher in the CAD group than in the non-CAD group [20.7% （45/217） vs. 9.3% （7/75）, P=0.015）]. Heavy smoking [odds ratio （OR）, 1.89; 95% confidence interval （CI）, 1.74-2.05], hypertension （OR, 1.56; 95% CI, 1.48-1.65）, alcohol （OR, 1.37; 95% CI, 1.30-1.46）, type 2 diabetes mellitus （OR, 1.37; 95% CI, 1.25-1.50）, high-fat diet （OR, 1.35; 95% CI, 1.28-1.43）, and BMI〉24 kg/m2 （OR, 1.09; 95% CI, 1.03-1.17） were factors related to CAD in the young patients （all P〈0.05）. Total cholesterol （4.56_±1.46 mmol/L vs. 4.09_±1.00 mmol/L）, low-density lipoprotein cholesterol （2.38±1.11 mmol/L vs. 2.14±0.63 rnmol/L）, lipoprotein a （134.97±109.70 mg/L vs. 101.58±58.39 mg/L）, uric acid （359.89_±100.09 μmol/L vs. 336.75±94.36 μmol/L）, erythrocyte sedimentation rate （9.98± 12.19 ram/hour vs. 4.89_±4.92 mm/hour）, high-sensitivity C-reactive protein （3.42±4.39 mg/L vs. 2.80±_3.77 mg/L） and Big endothelin-1 （1.41±1.50 fmol/mL vs. 0.77_±1.13 fmol/mL） in plasma were significantly increased in the CAD group compared with the non-CAD group （all P〈0.05）. Conclusions Heavy smoking, hypertension, alcohol consumption, type 2 diabetes mellitus, high-fat diet and BMI〉24 kg/m2 were significantly related to CAD in patients aged ≤40, with heavy smoking presenting the highest OR. Metabolic syndrome and inflammation were also more common in young CAD patients than in non-CAD patients.     

Langerhans Cell Histiocytosis on the Vulva： A Case Report and Review of the Literature

Langerhans cell histiocytosis （LCH） of the female genital tract is rare. Only 20 cases of primary vulva LCH have been previously reported in the medical literature. In this report, we describe an additional case of LCH on the vulva. A 28-year-old Chinese woman presented with a two-year history of ulcerous lesions on the left vulva. No associated temperature, tiredness, or general malaise was observed. A diagnosis of LCH had been made by biopsy. Histological and immunohistochemical findings were characteristic of LCH. After two weeks of combined medical therapy, including interferon, prednisone, and methotrexate （MTX）, the lesion started to cicatrize. Now, the patient was well throughout a 18-month follow up, showing no symptoms or signs of local recurrence or systemic spread. The occurrence of LCH on the vulva is very unusual. It is necessary to perform a biopsy on the lesion, rule out the possibility of multiorgan involvement. There are no standard treatment options for this rare disease. The most effective treatment options remain elusive. In our case, combined medical therapy was proved to be effective.     

Rhabdomyosarcoma of the Breast：A Clinicopathologic Study and Review of the Literature

Background  Rhabdomyosarcoma (RMS) is an uncommon malignancy of the breast. The aim of this study was to summarize its clinicopathologic features and biological behavior.

Methods  Five primary or secondary breast RMSs were collected. Their clinicopathological characteristics and all published literature about breast RMS were reviewed. Immunohistochemical study of desmin, myogenic differentiation 1 (MyoD1), myogenin, leukocyte common antigen (LCA), vimentin, cytokeratin (AE1/AE3), E-cadherin, neuron specific enolase (NSE), CD99, chorioallantoic membrane 5.2 (CAM5.2) and epithelial membrane antigen (EMA) expression were performed.

Results  The five patients were all female with ages ranging from 16 to 46 years old (mean, 30 years). Three were metastatic breast RMSs, two embryonal and one solid variant alveolar, with the primary tumor sites the right labium majus, left nasal meatus and nasopharynx, respectively. The other two, one embryonal and one alveolar, were primaries. Grossly, the surgical specimens revealed round or oval, well-demarcated but nonencapsulated masses. Their cut surfaces consisted of homogeneous grayish yellow or white tissue. Microscopically, most tumor cells were poorly differentiated small round, oval or small polygons with eosinophilic cytoplasm. All cases were positive for vimentin, desmin, MyoD1 and myogenin. One embryonal RMS also had a few cells with perinuclear staining of AE1/AE3. The other markers were negative.

Conclusions  Although primary or metastatic RMS in breast was almost confined to young adolescent females, our cases suggested that it can also happen to the middle-aged women. Embryonal RMS has a certain metastatic potential. MyoD1 and myogenin are two useful markers when making differential diagnosis. Axillary lymph node status and age may play a role in the prognosis of primary breast RMS patients.

     

Tumours of the Scalp： A Review of Ten Cases

Background： The scalp is a common site for the development of tumours. Most of these tumours are benign; among the malignant ones, squamous cell carcinoma （SCC）） and basal cell carcinoma （BCC） predominate. In Ghana patients with scalp turnouts do not report to hospital unless they are symptomatic. Data on the condition is therefore scanty. Patients and Methods： The objective of the study was to document the hospital prevalence and the management outcome of patients with scalp tumours. Patients with turnouts of the scalp reporting at the Reconstructive Plastic Surgery and Burns Unit （RPSBU） at Komfo Anokye Teaching Hospital （KATH） who were managed by the author between June 2003 and June 2009 were entered into the study. The patients were examined clinically and the diagnosis confirmed by biopsy. The scalp tumours were excised and the defect closed directly, skin grafted, or repaired with a flap as appropriate. Results： Ten patients with eleven scalp tumours were managed during the study period from June 2003 to June 2009, made up of four males and six females. Their ages ranged from 16 to 70 years, with a mean age of 41.7 years. Two benign scalp turnouts, a sebaceous cyst and a sebeceoma were located in the frontal region; five cases of SCC and one case of basosquamous cell carcinoma （BSC） in the parietal region, two cases of SCC in the temporal region, and one case of SCC in the occipital region of the scalp. Eight of the tumours developed de novo from the scalp; one developed from a chronic burn scar （Marjolin＇s ulcer）; two tumours developed from the scalp of a patient with xeroderma pigmentosum. Two patients had excision and direct closure of the defect; six had excision and skin grafting; two had excision and flap repair. One patient had block dissection of the left cervical lymph nodes, and two patients had adjuvant radiotherapy. Conclusions： Most tumours of the scalp presenting at the RPSBU at KATH are SCC which developed de novo. Chronic burn scars and xeroderma pigmentosum were some of the aetiological factors identified. Early lesions can be cured by excision and skin grafting.     

Primary Adenocarcinoma of the Epididymis： a Case Report and Literature Review

Objective: To promote the accuracy of diagnosis and the efficiency of treatment of primary epididyrnal adenocarcinoma. Methods: A 57 years old man was admitted in April 2000 with the right epididyrnal mass. We treated him as right epididyrnal neoplasm according to his symptom, physical examination, diagnostic therapy and specific carcinoernbryonic antigen about epididymis. Results: The patient suffered a right orchiectomy by transscrotal approach. The pathologic analysis displayed a right adenocarcinoma of the epididymis, grade Ⅱ-Ⅲ with a positive surgical margin of right spermatic cord, and immunohistochemical PSA staining was negative. Then a upper right spermatic cord excision and biopsy of the lymph nodes in pelvic cavity was performed. Intraoperatively, the metastasis disease was found during inguinal exploration. Metastasis or invaded adenocarcinoma was found in right sperrnatic cord and fibrous tissue based on pathologic examination. No intravascular metastasis was found. No furthermore treatment was given and the patient died half an year after diagnosis. Conclusion: The adenocarcinoma of the epididymis is easily misdiagnosed to be the tuberculosis of the epididymis and chronic epididymitis, and usually the neoplasm was poorly differentiated. The prognosis of these cases are very poor, and usually die in a short term.     

Selection of Diagnostic Indicators for Strangulated Intestinal Obstruction by Using Meta-analysis： A Report of 652 Cases and Review of the Literature

Objective To select the diagnostic indicators for strangulated intestinal obstruction （IO） in order to improve diagnostic accuracy. Methods Meta-analysis was used in the selection of diagnostic indicators for strangulated IO in the clinical data of total 652 cases with strangulated IO which had undergone treatment in our hospital or reported by literature. Results l0 diagnostic indicators for strangulated IO were selected. Among the 652 strangulated IO cases, 92% cases agreed with 2 or above diagnostic indicators, while among the 604 cases of control group with simple IO, only 3 cases agreed with 2 or above diagnostic indicators. No cases had 3 or above diagnostic indicators. Conclusion Based on the diagnosis of IO, the IO cases conforming to 2 or above diagnostic indicators were further diagnosed with strangulated IO. The selected 10 diagnostic indicators improved the diagnostic accuracy of SIO from 61% to 92%.     

Management of the occlusion and stenosis of the aortic arch branches in the course of Takayasu’s arteritis

Takayasu＇s arteritis （TA） is a chronic inflammatory disease of the aorta and its thoracic and abdominalparts, most commonly involving the aortic arch and the arteries that arise from it. TA is an autoimmune disease, although certain HLA-linked genetic predispositions have been observed. TA affects females 2 to 8 times more fi＇equently than males. The onset age is between 10 to 40 years old.1 TA is extremely uncommon in Poland. Corticosteroids are the choice of treatment for TA,     

Persistent Lymphocyst after Surgery on a Patient with Endometrial Carcinoma： A Case Report and Review of the Literature

Lymphocyst is one of the main complications of gynecologic malignancies following systematic lymphadenectomy. The majority are asymptomatic. But when it is large enough, the lymphocyst may oppress the ureters and it should be treated. A 48-year-old Chinese woman who had received a subradical hysterectomy plus systematic pelvic and para-aortic lymphadenectomy in our hospital because of endometrial cancer presented persistent lymphocyst. Her symptom was so obviously that we had to aspirate repeatedly in order to relieve its oppression to jacent organs. But the lymphocyst grow so fast and was so intractable, and we had to perform exploratory laparotomy and put negative pressure drainage. When the patient was discharged, the cyst still existed, but the patient was no symptom.     

Forty-two Patients with Takayasu Arteritis: Clinical,Laboratory and Angiographic Studies

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大动脉炎肾动脉狭窄/闭塞的介入治疗及临床观察

目的 评价大动脉炎肾动脉狭窄或闭塞介入治疗的疗效.方法 将白求恩国际和平医院血管外科2011年3月至2011年8月入住的53例大动脉炎肾动脉狭窄/闭塞的患者作为研究对象,53例患者接受综合性介入治疗,即对于大动脉炎肾动脉闭塞（RAO）患者,首先采用肾动脉穿通术,开通成功后接受肾动脉形成术或肾动脉支架植入术.对于大动脉炎肾动脉狭窄（RAS）患者,首选肾动脉形成术进行治疗,对于效果不理想者采用肾动脉支架植入术.随后对介入治疗成功率以及术前、术后1个月、术后6个月的血压和肾功能指标进行统计分析.结果 33例RAO患者中,30例行肾动脉穿通术成功后接受了肾动脉形成术或肾动脉支架植入术;3例肾动脉穿通术未成功;介入治疗成功率为90.9%.20例RAS患者,16例成功接受了肾动脉形成术;另外4例肾动脉形成术不理想,随后接受了肾动脉支架植入术;成功率为100%.综合介入治疗的成功率为94.3%.随访结果显示,术后1个月和6个月的收缩压和舒张压相对于术前均有显著降低（P＜0.05）,而术后1个月和术后6个月相差不大（P＞0.05）;血清肌酐水平在术后1个月和术后6个月下降到手术前的80%左右,肾小球滤过率也显著升高（P＜0.05）,而术后1个月和术后6个月相差不大（P＞0.05）.结论 采用综合介入治疗法治疗大动脉炎肾动脉患者的疗效显著,可在今后治疗中推广使用.     

头臂型大动脉炎的椎动脉血流彩超观察

目的:应用彩色多普勒超声检查头臂型大动脉炎不同病变类型的椎动脉血流变化.方法:选择2003年至2010年门诊及住院患者30例,均经DSA检查及临床检查证实,常规进行颈动脉、锁骨下动脉及椎动脉的检查.测量病变血管内中膜厚度及残余内径,彩色多普勒观察血流状态,方向及狭窄部位的血流参数.结果:所有病例均有不同程度的血管狭窄,...     

肾动脉型大动脉炎的外科治疗

肾动脉型大动脉炎造成的难治性高血压及肾功能不全是大动脉炎药物治疗的难点,临床面临难治性肾血管性高血压且肾动脉狭窄程度≥70%时,应积极考虑行外科手术治疗。可选择的治疗方式有开放手术或介入治疗,但目前对于术式的选择尚无明确指南。本文总结了开放手术、球囊扩张术、支架置入术的临床效果、长期通畅率及并发症发生率,旨在为肾动脉型大动脉炎的临床手术术式选择提供参考。     

伴大动脉炎的牙周炎1例

大动脉炎是一种罕见的慢性血管炎,患病率为每年（1.2~2.6）/100万,患者多为年轻女性［1］,病损主要累及主动脉及其分支［2］,其病因尚不明确,感染、自身免疫及遗传缺陷等都是可能的危险因素。美国风湿病学会对大动脉炎的诊断有明确规范［3］,大动脉炎的治疗主要包括药物（如类固醇类）和手术（如血管成形术）等［4］。由于大动脉炎可能不断进展并造成重要器官缺血,因此需长期监测患者的红细胞沉降率（erythrocyte sedimentation rate,ESR）及C反应蛋白（C reactive protein,CRP）水平来了解疾病的活动性。研究表明,牙周炎通过牙周致病菌和炎症因子与多种全身系统疾病（如糖尿病、冠心病和动脉粥样硬化等）存在着相关关系［5］,但目前还未见大动脉炎与牙周炎关系的相关报道,本研究将对1例伴大动脉炎的牙周炎患者进行报道。     

Treatment of cerebral aneurysms associated with Takayasu arteritis

Takayasu arteritis (TA) is a chronic inflammatory disease of the large elastic arteries that primarily affects the aorta and its major branches, resulting in luminal stenosis and aneurysmal changes in the large vessels [1,2]. Cerebral aneurysms and accompanying subarachnoid hemorrhage (SAH) are rare; no cases from China have been reported. We herein report two cases of TA with cerebral aneurysms that were successfully treated with coil embolization. Hemodynamic stress plays an important role in the formation of the cerebral aneurysms associated with TA. Patients with both TA and hypertension should maintain their blood pressure at a proper level and regularly undergo cerebral artery angiography or computed tomographic angiography (CTA) to screen for cerebral aneurysms.     

Treatment of cerebral aneurysms associated with Takayasu arteritis

Takayasu arteritis (TA) is a chronic inflammatory disease of the large elastic arteries that primarilyaffects the aorta and its major branches,resulting in luminal stenosis and aneurysmal changes in the large vessels.1 Cerebral aneurysms and accompanying subarachnoid hemorrhage (SAH) are rare;no case from China has been reported.We herein report two cases of TA with cerebral aneurysms that were successfully treated with coil embolization.     

有结核病史的大动脉炎患者临床特点分析

目的 分析有结核病史的大动脉炎（Takayasu arteritis,TA）患者临床表现、影像学及实验室检查的特点。方法 连续收集住院的TA患者,按照有无结核病史分为2组,比较临床特点、影像学及实验室指标的差异。结果 103例TA患者中,既往有结核病史者19 例,占18.45%,其中肺结核者15例,结核性胸膜炎者2例、支气管内膜结核者1例,结核性腹膜炎者1例。与无结核病史的TA患者比较,有结核病史的TA患者头晕症状降低、外周血中性粒细胞数减少、血清肌酐水平升高、血清补体C3、C4水平降低,差异有统计学意义（P<0.05）。有结核病史者结核分枝杆菌γ扰素释放高于无结核病史者（P<0.05）。有结核病史的TA患者影像学分型以V型最为常见（63.16%）,其次是Ⅱb型（15.79%）;有结核病史的TA患者冠状动脉受累的比例为10.53%,肺动脉病变的比例为15.79%,瓣膜病变73.68%,但与无结核病史TA患者比较,差异均无统计学意义（P>0.05）。结论 TA患者既往结核感染比例高,有结核病史的TA患者外周血中性粒细胞数减少、血清肌酐水平升高、血清补体C3、C4水平降低。