Foreign travel for advanced cancer patients: a guide for healthcare professionals

The opportunity for a patient with advanced cancer to travel abroad may, for some, be a life affirming event during a dark period in their life. For others, what they hoped to be a time of joy may become an unmitigated disaster if they become unwell while away from the safety net of local cancer services. The rise of low budget airlines and cheaper foreign travel has led to an increase in the number of people travelling by air. Health professionals are more likely to face requests by patients to advise them on travel plans. Although foreign travel is an unrealistic goal for some patients, appropriate forward planning and proactive management can allow some patients to make an important journey abroad. This paper looks at the practical issues facing cancer patients who intend to travel overseas and offers practical advice on considerations that need to be made.     

Ultrasound-triggered microbubble destruction in combination with cationic lipid microbubbles enhances gene delivery

This study aimed to examine the preparation of cationic lipid microbubble(CLM),and evaluate its physical and chemical properties and toxicity,measure the gene transfection efficiency by ultrasound triggered microbobble destruction(UTMD) in combination with CLM.The CLM was prepared by the method of the thin film hydration,and its morphology was observed under the electron microscopy at 1st,3rd,7th,10th,and 14th day after preparation,respectively.The size,Zeta potential and stability of CLM were tested.The acute toxicity of CLM was assessed.The green fluorescent protein gene(EGFP) transfection efficiency was evaluated.The experiment grouping was as follows:naked plasmid group(P group),ultrasonic irradiation plus naked plasmid group(P-US group),naked plasmid plus CLM group(P-CLM group),naked plasmid plus ultrasound and CLM group(UTMD group).The expression of EGFP was detected by fluorescent microscopy and flow cytometry.The results showed that CLMs were spherical in shape,with the similar size and good distribution degree under the light and electron microscopies.The size of CLMs was varied from 250.4±88.3 to 399.0±99.8 nm and the Zeta potential of CLMs from 18.80±4.97 to 20.1±3.1 mV.The EGFP expression was the strongest in the UTMD group,followed by the P-CLM group,P-US group and P group.Flow cytometry results were consistent with those of fluorescent microscopy.The transfection efficiency was substantially increased in the P-US group,P-CLM group and UTMD group as compared with that in the P group,almost 7 times,10 times and 30 times higher than that in the P group respectively.It is suggested that CLMs prepared by the method of thin film hydration are uniform in diameter,and proved non-toxic.UTMD combined with CLM can significantly increase the transfection efficiency of EGFP to targeted cells.     

Posterior pharyngeal tension pneumatocele

This unusual clinical entity is presented as a rare variant of the more common posterior pharyngeal abscess. The more important considerations discussed are: (a) the necessity for routine chest radiography in a case of “croup”, including a view of the laryngeal area to rule out a foreign body; (b) the importance of routine and regular follow-up after removal of a laryngeal or esophageal foreign body, including close consultation with the radiology department; and (c) the inherent life-threatening nature of the condition and the possible need for surgical intervention on an emergency basis.     

Cutaneous leishmaniasis: a report of two cases seen at a tertiary dermatological centre in Singapore

Cutaneous leishmaniasis (CL) is not common in South-East Asia and often presents as a granulomatous plaque on the exposed areas, with a high index of suspicion required for diagnosis. Two such cases were seen at the National Skin Centre recently, and both were Gurkha men with a history of travel to Belize. They were treated with intravenous sodium stibogluconate with success. A discussion on CL and its management follows.     

Rasmussen’s encephalitis: A case report

Rasmussen’s encephalitis (RE) is a rare neurological disorder of inflammatory aetiology characterised by encephalitis, intractable seizures, hemiparesis, variable motor deficits, and dementia. It is not commonly considered in the clinical differential diagnosis of a patient with a past history of a stroke-like episode presenting with status epilepticus. It is suspected mainly in children in whom the disease is more common. Here we report a case of an adult man presenting with a common symptom of seizure caused by Rasmussen’s encephalitis.     

Brucellosis linked to Mexican cheese.

Three cases of brucellosis occurred, two acute cases and one chronic, all of which likely resulted from the ingestion of fresh cheese containing Brucella melitensis. A history of patients with illness suggestive of brucellosis should include details about food ingested recently in addition to the usual questions about travel and occupation. As the US domestic-animal disease comes under better control, and travel to Mexico, Spain, and Italy increases, it seems likely that human disease caused by B melitensis will become relatively more common.     

Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management

STRONGYLOIDIASIS, WHICH IS CAUSED by the nematode Strongyloides stercoralis, is a common and persistent infection, particularly in developing countries. In the setting of compromised cellular immunity, it can result in fulminant dissemination with case-fatality rates of over 70%. The majority of new Canadian immigrants come from countries where Strongyloides is highly endemic; therefore, the burden of Strongyloides may be underappreciated in Canada. Because early diagnosis and therapy can have a marked impact on disease outcome, screening for this infection should be considered mandatory for patients who have a history of travel or residence in a disease-endemic area and risk factors for disseminated disease (e.g., corticosteroid use and human T-lymphotropic virus type I infection).     

手术切除在结直肠癌肝转移治疗中的意义及预后

目的 探讨手术切除对结直肠癌肝转移的疗效及预后影响因素.方法 回顾性分析施行肝切除术的35例结直肠癌肝转移患者的临床及随访资料.Kaplane-Meier法分析生存率.多因素预后分析采用Cox逐步回归法.结果 全组总的1、3和5年累计生存率分别为93.5%、68.5%和39.9%.单因素分析显示转移瘤最大直径、手术切缘、淋巴结转移、肝转移类型及转移瘤病理分化程度对生存率有显著影响;多因素分析显示肝转移瘤最大直径(P=0.012)、手术切缘(P=0.027)是影响生存率的独立因素.结论 结直肠癌肝转移的外科治疗可使患者获得长期生存.最大转移瘤直径小于5.0cm、手术切缘阴性预示结直肠癌肝转移手术切除预后较好.     

小儿支气管异物的临床与影像学表现

目的　探讨小儿支气管异物的临床与影像学表现 ,提高诊断正确率。方法　搜集经纤维支气管镜或手术证实的小儿支气管异物 4 1例 ,统计并分析临床、胸部透视、胸部X线摄片及CT检查结果。结果　 4 1例中 ,根据异物吸入史及临床表现 34例首次作出临床诊断 ,7例无明确异物吸入史者 6例经CT作出诊断 ,1例经纤维支气管镜作出诊断 ;透视检查诊断符合率为 32 % ,漏诊率为 34% ;摄片诊断符合率为 72 % ;CT诊断符合率为 10 0 %。结论　支气管异物的诊断很大程度上取决于临床病史。胸部透视漏诊的主要原因是透视医生经验的缺乏及临床提供的病史不详。临床上无明确异物吸入史者有赖于CT检查     

Clinics in diagnostic imaging (152). Right lower lobe segmental pulmonary embolus.

A 56-year-old man presented to the Accident and Emergency Department with pleuritic chest pain of sudden onset. He gave a history of short-distance air travel ten days earlier. Chest radiograph showed a peripheral-based opacity in the right lower zone, which was not seen in a previous study done three months ago, suggestive of Hampton’s hump. The D-dimer level was raised. Computed tomography pulmonary angiography confirmed the diagnosis of pulmonary embolism in a right lower lobe segmental branch, with adjacent collapsed lung, consistent with lung infarction. The patient was started on heparin injection with significant relief of his symptoms. The clinical and imaging features of pulmonary embolism are described, with emphasis on the historical radiographic signs and the current dual-energy computed tomography innovations.     

Inhaled foreign bodies in a paediatric population at AKTH Kano-Nigeria

Background:

Inhaled foreign bodies are common paediatric emergencies and a major cause of accidental deaths at home among Nigerian children especially among children below the age of 5 years. Different types of foreign bodies have been reported from the ordinary to the most bizarre. We evaluated the types of foreign bodies and sites of possible impaction of these foreign bodies along the tracheobronchial tree.

Materials and Methods:

A 6-year case record of 35 patients with foreign body inhalation was reviewed from January 2005 to December 2010 at the Otorhinolaryngology Department of Bayero University/Aminu Kano Teaching Hospital, Kano — North-western Nigeria. Basic information such as date of birth, age groups, gender, indication for bronchoscopy, type of foreign bodies, sites of foreign body impaction and surgical outcome were extracted and analysed.

Results:

Thirty-five patients [18 (51.4%) males and 17 (48.6%) females, aged 6 months-10 years] with a mean age of 5.1 years and median of 5 years (+/- 3.0 Standard Deviation). The most affected age group with 31.4% is 3-5 years. Groundnuts and whistles were the most frequently inhaled foreign bodies with an equal frequency of 25.7%, respectively. Foreign bodies were preferentially lodged in the left main bronchus in 8 (22.9%) patients compared to the right main bronchus in 6 (17.1%) patients.

Conclusion:

Public enlightenment both in the news/print media on the risk of foreign body aspiration especially among the under-five''s is highly advocated. The left main bronchus may be a common site for impaction as well.     

角巩膜铁屑样异物1例

目的 对1例隐匿性角巩膜铁屑样异物患者的临床表现、影像学特征、手术方法进行分析,以提高临床医生对于该病的诊疗能力。方法 回顾我院收治的1例诊断为角巩膜异物患者的临床资料并进行分析,结合相关文献对该疾病进行总结。结果 患者为31岁男性,左眼被铁屑崩伤1个月余,伤后曾于外院行异物取出治疗,仍有异物感,眼科查体见前房角脓栓,但未见明显异物,经眼眶CT、超声生物显微镜(UBM)检查后确诊为角巩膜异物,随后手术治疗取出异物。结论 角巩膜异物是常见的眼外伤之一,但是对于病程较长的角巩膜异物,眼科查体往往难以发现,接诊此类患者时,应尽可能详细地采集病史、完善辅助检查,可减少该病的漏诊率。     

衡阳市主要先天肢体畸形的流行病学分析

目的 了解衡阳市新生儿中先天肢体畸形(congenital limb malformations,CLM)的病种分布及流行病学特征。 方法 整群抽样选取衡阳市南岳区、珠晖区、常宁市和衡山县4个区县,调查2008~2010年间新生儿中CLM的发生情况。根据伴发畸形的性质将CLM病例分为单发和综合征两类,分别计算其发生率,分析病种构成及患儿临床特征。 结果 52 307例新生儿中检出170例CLM,总发生率为32.50/104,单发畸形发生率为28.29/104,综合征为4.21/104;其中多指(趾)、马蹄内翻足、并指(趾)和肢体短缩的发生率分别为13.00/104、9.56/104、5.16/104、3.63/104。CLM总发生率及病种发生率无城乡、性别和孕妇年龄别差异。多指(趾)、并指(趾)、肢体短缩三种畸形发生在上肢、下肢、上下肢的比例分别为68.14%、14.16%、17.70%。综合征CLM患儿中早产、低出生体质量、死胎死产及新生儿期死亡多于单发CLM患儿。 结论 衡阳市先天肢体畸形发生率和病死率高,需采取有效措施预防疾病,提高患儿的生存质量。     

Novel cases of blastomycosis acquired in Toronto, Ontario

Blastomycosis, a potentially fatal fungal disease, is well known from defined areas of endemicity in Ontario, primarily in the northern part of the province. We present 2 unusual cases that appear to extend the area of endemicity into urban southern Ontario, specifically Toronto. Both patients presented to a dermatology clinic with skin lesions. Chest radiography, history and general physical evaluation indicated no disease at other body sites. Both cases appeared to represent “inoculation blastomycosis” connected with minor gardening injuries and a cat scratch respectively. Atypical dissemination could not be completely excluded in either case. Neither patient had travelled recently to a known area of high endemicity for blastomycosis, nor had the cat that was involved in one of the cases. Physicians must become aware that blastomycosis may mimic other diseases, including dermal infections, and may occur in patients whose travel histories would not normally suggest this infection.     

应用纤维喉镜诊治喉咽异物

目的：探讨喉咽部隐匿性、细小异物的治疗方法。方法：对21例异物史明确,常规方法无法窥见或取出困难的患者行纤维喉镜检查。结果：21例均一次发现异物并钳取成功。结论：纤维喉镜诊治喉咽部隐匿性及可疑异物创伤小,成功率高。     

我国中南地区244例成人气管支气管异物特点分析

目的气管支气管异物（TFBs）吸入可发生在各个年龄阶段,而成人TFBs报道较少。本研究报道了我国中南地区的成人TFBs的危险因素、特点及应用支气管镜取异物的经验。方法我们回顾性检索了1997年1月至2012年2月14岁以上的气管支气管异物患者,分析其发病率、危险因素、临床表现、影像学特点,以及异物种类和异物部位。结果在27719例行支气管镜检查的患者中有244（0．88％）例发现了TFBs。50岁以上的患者,年龄越大,发病率越高;70-80岁年龄段发病率达0．62％。仅在32例（6．6％）患者发现了脑血管疾病和神经退行性疾病等危险因素。在153例有明确异物吸入史的患者中,135例（88．2％）的异物吸入与食用了辣椒且饮食时大声交谈有关。最常见的临床表现为阵发性咳嗽（81．1％）。胸部X线片发现不透光异物的仅有12例（4．9％）,而胸部CT发现不透X线的异物有106例（43．4％）。最常见的间接胸部影像学表现为同一部位反复的肺部感染或实变（34．4％）。最常见的异物种类为动物骨头碎片（47．2％）。异物最常见的定位是在右侧支气管（65．6％）,可曲式支气管镜成功取出异物234例（95．9％）。结论虽然TFBs在中国南方地区的成年人中并不常见,但其支气管镜发现率（0．88％）明显高于西方的报道（0．32％-0．33％）,饮食嗜好辣椒和饮食时大声交谈可能是我国中南地区高发病率的主要危险因素。     

近五年来中国医学史研究的进展

近五年来中国医学史研究在原有的基础上又有了新的进展。在以少数民族医学史、近现代医学史、中外医学交流史和比较史研究为主题的全国医史会议召开之后，这些领域的研究有显著的进步，有关论文和专著明显增加。卫生部组织编撰的巨著《中国医学通史》，有力地推动医学通史研究的深入。此外，专科史、疾病史、医家医著、医史理论、世界医学史研究也有新的进展。国际间的学术交流日益频繁。但也存在人才外流，医学史课程尚未列入中华医学会继续教育，疾病史、世界史、医史理论研究薄弱等问题，有待解决和加强。港澳台医学史研究新领域将得到开拓。     

Toxic leucoencephalopathy after ‘chasing the dragon’

Toxic leucoencephalopathy (TLE) is a rare neurological complication of heroin abuse. ‘Chasing the dragon’ is an inhalational mode of heroin abuse that originated in Southeast Asia. Intriguingly, no cases of TLE have been reported from this region, although the inhalational mode of heroin abuse is common. We herein report the case of a middle-aged man with a history of polysubstance abuse who presented with progressive neurological symptoms and progressed to an uncommunicative state. While the initial impression was that of iatrogenic parkinsonism, diffuse leucoencephalopathy with sparing of the cerebellum was noted on magnetic resonance imaging. In view of his history of inhalational heroin abuse close to the onset of the neurological symptoms, a diagnosis of TLE was made. No clinical improvement was noted with administration of a dopaminergic agent. This is the first known case of delayed TLE following heroin inhalation from Southeast Asia with the unusual feature of cerebellar sparing.     

Tongue cleaner,an unusual foreign body in the urethra: A case report

Introduction

Various cases of self-inflicted foreign body insertion into the urethra have been reported in adult males. The most common motive for such acts has been postulated as autoerotic stimulation, psychiatric illness or intoxication.

Case presentation

A 40-year-old male presented with a partially inserted tongue cleaner in his urethra with one end projecting from the urethral meatus and with a history of bleeding and pain. After a gentle attempt of removal using local anaesthetic gel the patient was scheduled for its surgical removal under anaesthesia.

Conclusion

Large complex foreign bodies may be not amenable to endoscopic removal and may warrant open surgical procedure. Urethral stricture should be suspected in such patients. A psychiatric visit should be recommended for all adult males with self-inflicted foreign body in the urethra.     

Symptoms and signs of malaria.

In addition to asking their patients about recent foreign travel, Canadian doctors need to be aware of what features to ask about in considering imported illnesses. Of these illnesses, malaria is one of the most common and serious. Because of its cerebral renal, pulmonary and intestinal complications, falciparum malaria must be distinguished from non-falciparum forms. Anyone with a fever who has arrived recently from an endemic area should be tested for malaria. In addition, headache, malaise, myalgias, arthralgias, low back pain, nausea, vomiting, diarrhea or cough should raise suspicion. Malaria should be remembered as a cause of coma. Persons taking any form of drug prophylaxis for malaria are not protected absolutely and those who are semi-immune can become severely ill occasionally.