Secondary paroxysmal dyskinesias.

Paroxysmal dyskinesias (PxDs) are involuntary, episodic movements that include paroxysmal kinesigenic (PKD), paroxysmal nonkinesigenic (PNKD), and paroxysmal hypnogenic (PHD) varieties. Although most PxDs are primary (idiopathic or genetic), we found 17 of our 76 patients with PxD (22%) to have an identifiable cause for their PxD (10 men; mean age, 41.4 years). Causes included peripheral trauma (in three patients), vascular lesions (in four), central trauma (in four), kernicterus (in two), multiple sclerosis (in one), cytomegalovirus encephalitis (in one), meningovascular syphilis (in one), and migraine (in one). The latency from insult to symptom onset ranged from days (trauma) to 18 years (kernicterus), with a mean of 3 years. Nine patients had PNKD, two had PKD, five had mixed PKD/PNKD, and one had PHD. Hemidystonia was the most common expression of the paroxysmal movement disorder, present in 11 patients. Both of the patients with PKD had symptom durations of <5 minutes. Symptom duration ranged from 10 seconds to 15 days for PNKD and from 5 minutes to 45 minutes for mixed PKD/PNKD. There were no uniformly effective therapies, but anticonvulsant drugs, clonazepam, and botulinum toxin injections were the most beneficial. Awareness of the variable phenomenology and the spectrum of causes associated with secondary PxD will allow for more timely diagnosis and early intervention.     

选择性子宫动脉栓塞治疗症状性子宫肌瘤

目的:评价选择性子宫动脉栓塞 (U AE)治疗症状性子宫肌瘤 (SUF)的临床疗效。方法:12例 SUF患者行双侧子宫肌瘤供血动脉的栓塞治疗 ,栓塞剂为聚乙烯醇微球颗粒 (PVA)。结果:栓塞成功率 10 0 % ,无严重并发症发生。随访 3～ 2 4个月 ,B超示术后 6个月肌瘤平均缩小 4 5 % ,1例肌瘤消失 ,均伴有月经量的明显减少。 结论 :U AE是治疗 SU F的安全方法 ,近期疗效肯定。     

因症就诊检出早期大肠癌的临床及病理学特征

目的探讨在就诊的肛肠病人中如何提高早期大肠癌的检出率。方法在１１家医院推广对肛肠病人的四项检查程序——直肠指检，乙结镜检查，大便隐血试验，和Ｘ线气钡灌肠造影。结果在４８２１例有肛肠症状的病人中，检出大肠癌１８８例，检出率为３．９％，其中１８０例有术后病理诊断。４７／１８０例（２６．１％）属早期癌（ＤｕｋｅｓｓｔａｇｅＡ）。４１／４７例由上述四项检查作出初步诊断。初发症状为：（１）便血（２６例，持续１５．２±９．４周后就诊，肿瘤平均直径２．５８ｃｍ）；（２）大便习惯改变（９例，３３．４±１９．７周，３．３９ｃｍ）；（３）腹痛腹块（１０例，１９．２±１１．２周，５．０ｃｍ）；（４）贫血（２例，１７．２±９．９周，４．７５ｃｍ）。８／１２例的Ａ０和Ａ１期病例属便血组，并多位于直肠。４１／４７例以高、中分化腺癌为主，其中１５例伴有腺瘤癌变。术前曾作活检的２７例中，１２例未检出癌变细胞。结论四项检查对检出早期大肠癌是有效的，便血是提示早期癌最有价值的症状，加强大肠癌防治宣教，采用瘤灶多点或全瘤活检技术，高度重视大肠腺瘤和不典型增生等癌前病变，将有助于提高早期大肠癌的检出率     

Evaluation of patients with symptomatic dermographism

BACKGROUND: Dermographism or 'simple' dermographism, which has been noted in about 1.5% to 5% of healthy individuals, is regarded as a normal physiological phenomenon. However, in symptomatic dermographism (SD), even light pressure or rubbing from clothes may provoke widespread weal-and-flare reactions with itching and burning. It is one of the dermatologic diseases that negatively impacts quality of life. OBJECTIVE: We aimed to reveal triggering factors and/or associated clinical conditions in patients with SD. METHODS: Forty patients (28 women and 12 men) with SD whose ages varied between 7 and 65 (30.3 +/- 10.7) participated in the study. Patients having chronic idiopathic urticaria, other types of physical urticaria and cutaneous/systemic mastocytosis were excluded. The diagnosis of SD was confirmed by stroking the skin of the back with a tongue blade. This procedure elicited within minutes a linear weal with a flare and severe itching. In light of the history, physical examination, skin prick test (SPT) with aeroallergens and laboratory results, a possible relationship of certain triggering factors and/or associated diseases (psychic factors, atopy, thyroid diseases, diabetes, menopause, infectious, systemic or malignant diseases, history of scabies, and history of drug reaction) to SD were investigated. RESULTS: The duration of SD varied between 10 days and 10 years (mean: 20.8 months). Psychic factors were found to play the initial triggering role in 12 patients (30%). Five patients (12.50%) were atopic, and they had SPT reactivity to house dust mites. Three female patients (7.50%) defined that their complaints began following drug-induced urticarial rash. Two patients (5%) had hyperthyroidism, and one of the patients with SD of 1-month duration had type-II diabetes mellitus. A female patient defined that her complaints began during the onset of menopausal period. SD was observed with scabies in one patient; and after poststreptococcal glomerulonephritis in a 7-year-old girl. No autoimmune, malignant or other systemic diseases were found in patients with SD. CONCLUSIONS: Contrary to commonly held opinion, SD may be associated with some diseases and/or triggered by some conditions. In this study, a close temporal relationship between the appearance of SD and psychic factors, drug reactions and scabies was documented. The relation between SD and atopy, hyperthyroidism, diabetes mellitus, menopause and glomerulonephritis seemed unclear.     

经颅多普勒超声对原发性帕金森病和血管性帕金森综合征检查的临床意义

目的探讨经颅多普勒超声(TCD)对原发性帕金森病(IPD)和血管性帕金森综合征(VPS)的临床应用价值和意义。方法对81例IPD和32例VPS患者的TCD和颅脑CT的检查结果进行比较研究。结果IPD组81例中总异常血管支数为223支(30．59％);VPS组32例中总异常血管支数为163支(56．60％);异常形式两组均以左侧大脑中、后动脉血流速度减慢为主要特点。结论IPD和VPS患者均伴有脑部血流动力学改变,VPS组的异常率高于IPD组,异常特点是左侧血流速度显著慢于右侧。     

Coronary Arteriovenous Fistulae: A Review

Coronary arteriovenous fistulae are a coronary anomaly, presenting in 0.002% of the general population. Their etiology can be congenital or acquired. We present a review of recent literature related to their epidemiology, etiology, pathophysiology, clinical presentation, diagnostic approach, and therapeutic management.