Clinical spectrum of primary cutaneous CD30‐positive anaplastic large cell lymphoma: an analysis of the Mannheim Cutaneous Lymphoma Registry

Background: Primary cutaneous CD30⁺ anaplastic large cell lymphomas (C‐ALCL) have indolent clinical behavior with an estimated 5‐year survival rate of 95%. The clinical features and disease courses of C‐ALCL identified in the lymphoma registry of Mannheim University hospital are described in the following. Patients and methods: All C‐ALCL patients identified in the database were analyzed in regard to clinical picture, histology, immunohistochemistry, molecular biology, staging, therapy, follow‐up, and outcome. Results: 14 C‐ALCL patients were identified. The mean age was 69 years and 57% were men. Solitary skin lesions in one anatomical region were seen in 12 patients upon initial diagnosis. Two patients presented with multiple lesions at different anatomical sites. In 2 patients there was specific lymph node involvement. In one C‐ALCL patient, follow‐up over 17 months revealed extracutaneous infiltration. Half of the patients relapsed and 36% had multiple episodes. The majority of our patients were treated with surgical excision followed by electron beam radiotherapy. The 5‐year survival rate was 93% in C‐ALCL. Conclusions: The clinical presentation of C‐ALCL varies. Staging procedures and a close clinical pathological correlation at initial diagnosis are essential. Due to a high rate of relapses and the possibility of developing extranodal manifestations over the course of the disease, close follow‐up is recommended.     

胃溃疡穿孔修补术在基层医院的应用再探讨

目的探讨胃溃疡穿孔修补术在基层医院的应用。方法回顾性分析我院外科2006年1月—2011年12月47例胃溃疡穿孔行修补术患者的临床资料。结果 47例均进行了穿孔修补术,其中45例行电话和门诊检查随访,随访时间为6个月~36个月,无1例发生癌变。结论在基层医院单纯修补术仍是胃溃疡穿孔的主要手术方法,但是必须严格掌握手术指征,彻底性手术仍不能摒弃,临床医师要权衡利弊选择最佳治疗方案,并严格执行随访制度。     

电话随访对妊娠期糖尿病孕妇遵医行为及妊娠结局的影响

目的探讨电话随访对妊娠期糖尿病(GDM)孕妇遵医行为及妊娠结局的影响。方法选择2013年10月~2014年10月在我院就诊的100例GDM孕妇,随机分为研究组和对照组,各50例。对照组采用常规护理。研究组在常规护理的基础上采用电话随访指导。比较两组遵医行为及各项临床参数和妊娠并发症。结果研究组遵医行为明显优于对照组;增重、空腹血糖、餐后2h血糖、糖化血红蛋白均控制在正常范围;妊娠期高血压、早产、巨大儿、羊水过多等妊娠并发症发生率均低于对照组,两组比较有显著性差异(P0.05)。结论电话随访能帮助GDM孕妇提高遵医行为,较好地控制血糖,从而有效降低GDM孕妇并发症的发生。     

Streptokinase may play role in expanding non-operative management of infected walled off pancreatic necrosis: Preliminary results

Goals and backgroundWe evaluated ex and in vivo effect of streptokinase on pancreatic necrosum to improve the success rate of pigtail catheter drainage and irrigation in infected walled off pancreatic necrosis using step up approach and also looked at potential risk of bleeding.Experiment and clinical cases1000 IU/ml of streptokinase was added to 10 g. of intra-operatively obtained fresh tissue of peripancreatic necrosis and results compared to treatment with saline. Mixture was incubated for 12 h in thermostat at 37.5 °C and subjected to histopathology. Subsequently streptokinase (50,000 units thrice a day for 5 days through PCD) was used in two patients with walled off pancreatic necrosis (WOPN) not responding to step up approach and who were being considered for surgery.Grossly there was fragmentation of necrosum in streptokinase treated tissue. Microscopically complete loss of supportive collagenous framework was noted in streptokinase treated necrosum with clumping of necrotic tissue into structure-less mass. No such changes were discernible in saline treated tissue. In two patients with WOPN there was clearance of debris after streptokinase instillation. None of the patients was on thromboprophylaxis and bleeding was not noticed in any of the patients.ConclusionBased on ex vivo effect of streptokinase in dissolution of necrosum at periphery, we believe that in patients with walled off pancreatic necrosis (WOPN) not responding to pigtail catheter drainage and saline irrigation; streptokinase may prove to be useful adjunct.