A pregnant woman with hepatitis A and Guillain-Barré

Guillain-Barré syndrome (GBS) is often preceded by an infectious disease. A case of GBS after hepatitis A in a pregnant woman is described. The patient was treated with intravenous immunoglobulin and had full recovery with no neurologic sequelae. She gave birth in term to a healthy baby. This is the first reported case in the English literature of a triple condition of hepatitis A, GBS, and pregnancy.     

Diabetes mellitus with hepatic infarction： A case report with literature review

Hepatic infarction rarely occurs due to the double supply of arterial and portal inflow. A 53-year-old man with diabetes mellitus developed multiple hepatic infarctions after an episode of fever and diarrhea. The infarction was documented by pathology after partial liver resection. Several causes of hepatic infarction may present in this patient: dehydration and hypotension caused by fever and diarrhea, type 2 diabetes and administration of glibenclamide, diabetic ketoacidosis and widespread atherosclerosis. We suggest that diabetic patient with elevated liver enzyme should be considered the possibility of hepatic infarction.     

A anorectal fistula treatment with acellular extracellular matrix： A new technique

AIM： To investigate a new technique of the anorectal fistula treatment with acellular extracellular matrix （AEM）. METHODS： Thirty patients with anorectal fistula were treated with AEM. All fistula tracts and primary openings were identified using conventional fistula probe. All tracts were curet-ted with curet and irrigated with hydrogen peroxide and metronidazole. The AEM was pulled into the fistula tract from secondary to primary opening. The material was secured at the level of the primary opening. The excess AEM was trimmed at skin level at the secondary opening. RESULTS： All of the 30 patients had successful closure of their fistula after a 7-14 d follow-up. The healing rate of anal fistula in treatment group was 100%. The ache time, healing time and anal deformation of treatment group were obviously superior to traditional surgical methods. CONCLUSION： Using AEM anal fistula plug in treatment that causes the anorectal fistula is safe and successful in 100% of patients. It can reduce pain, shorten disease course and protect anal function.     

Perioperative care for patient with end?stage heart diseasecombined with type A aortic dissection: A case report

正XU Xiao?feng1, CHENG Yun?qing1*, KUANG Jun?tao2, XIE Xue?jun1, HUANG Jing?song1,WU Yan?fen1, LAN Xue?ying1, FAN Rui?xin1, SUN Tu?cheng1     

A series of 22 patients with adult-onset Still's disease presenting with fever of unknown origin. A difficult diagnosis?

Adult-onset Still's disease (AOSD) remains a perplexing, difficult to diagnose clinical entity, with clinical characteristics that are often broad and encountered in numerous other clinical entities. This vague clinical presentation is depicted in the commonly used diagnostic criteria, as the ones by Yamaguchi and Fautrel. The authors sought to investigate how diagnostic criteria apply in a series of 22 new cases of AOSD patients presenting with fever of unknown origin (FUO) and diagnosed at the Internal Medicine Department of Hatzikosta General Hospital of Ioannina, Greece. The aims of the study were: (1) to study the incidence of AOSD and (2) to retrospectively apply different classifications to the data of these patients in search of a more efficient way of diagnosing these patients in the future. The annual incidence of AOSD was estimated at two new cases per 10⁵. The clinical manifestations of the patients are discussed, with an emphasis on specific manifestations being considered as criteria by Yamaguchi and Fautrel classifications. Four patients exhibited markedly increased serum d-dimers, a finding of which the potential pathophysiologic implications are discussed. Serum ferritin levels have additive values, both for diagnostic and cost-reduction purposes in cases presenting as FUO; serum ferritin values are not included in any diagnostic set of criteria at present. The finding of high levels of d-dimers in AOSD needs further studies.     

Hepatic encephalopathy with status epileptics： A case report

A 62-year-old male with decompensated liver cirrhosis due to hepatitis C virus developed severe hepatic encephaiopathy with status epileptic us. The blood ammonia level on admission was more than twice the normal level. Brain computed tomography and magnetic resonance imaging were normal. In addition, electroencephalogram showed diffuse sharp waves, consistent with hepatic encephaiopathy. The status epilepticus was resolved after antiepileptic therapy (phenytoin sodium) and treatment for hepatic encephaiopathy (Branched chain amino acids). The blood ammonia level normalized with the clinical improvement and the patient did not have a recurrence of status epilepticus after the end of the antiepileptic treatment. Additionally, the electroencephalogram showed normal findings. Thus, we diagnosed the patient as hepatic encephaiopathy with status epilepticus. We consider the status epilepticus of this patient to a rare and interesting finding in hepatic encephaiopathy.     

Necrotizing enterocolitis： A multifactorial disease with no cure

Necrotizing enterocolitis is an inflammatory bowel disease of neonates with significant morbidity and mortality in preterm infants. Due to the multifactorial nature o the disease and limitations in disease models, early diagnosis remains challenging and the pathogenesis elusive. Although preterm birth, hypoxic-ischemic events formula feeding, and abnormal bacteria colonization are established risk factors, the role of genetics and vasoactive/inflammatory mediators is unclear Consequently, treatments do not target the specific underlying disease processes and are symptomatic and surgically invasive. Breast-feeding is the most effective preventative measure. Recent advances in the prevention of necrotizing enterocolitis have focused on bioactive nutrients and trophic factors in human milk. Developmen of new disease models including the aspect of prematurity that consistently predisposes neonates to the disease with multiple risk factors will improve our understanding of the pathogenesis and lead to discovery of innovative therapeutics.     

Prognostic factors in patients with node-negative gastric carcinoma： A comparison with node-positive gastric carcinoma

AIM: To identify the clinicopathological characteristics of lymph node-negative gastric carcinoma, and also to evaluate outcome indicators in the lymph node-negative patients. METHODS: Of 2848 gastric carcinoma patients, 1524 (53.5%) were lymph node-negative. A statistical analysis was performed using the Cox model to estimate outcome indicators. RESULTS: There was a significant difference in the recurrence rate between lymph node-negative and lymph node-positive patients (14.4% vs 41.0%, P<0.001). The 5-year survival rate was significantly lower in lymph node-positive than in lymph node-negative patients (31.1% vs 77.4%, P<0.001). Univariate analysis revealed that the following factors influenced the 5-year survival rate: patient age, tumor size, depth of invasion, tumor location, operative type, and tumor stage at initial diagnosis. The Cox proportional hazard regression model revealed that tumor size, serosal invasion, and curability were independent, statistically significant, prognostic indicators of lymph node-negative gastric carcinoma. CONCLUSION: Lymph node-negative patients have a favorable outcome attributable to high curability, but the patients with relatively large tumors and serosal invasion have a poor prognosis. Curability is one of the most reliable predictors of long-term survival for lymph node-negative gastric carcinoma patients.     

Mucopolysaccharidosis I under enzyme replacement therapy with laronidase—A mortality case with autopsy report

There is little information about MPS I-related complications during laronidase therapy. We describe the first autopsy report of a young male MPS I patient who died of infection-induced cardiopulmonary failure following 2 years of weekly treatment with laronidase.     

Do Patients with Alcohol Dependence Use More Services? A Comparative Analysis with other Chronic Disorders

OBJECTIVE: The primary purpose of this research was to compare the service use of patients diagnosed with alcohol dependence to the service use of patients diagnosed with other chronic illnesses. The secondary purpose was to determine the impact of comorbid alcoholism on the service use of patients with chronic illnesses. METHODS: The sample included 67,878 veterans diagnosed with alcohol dependence, depression, or diabetes who were treated by the Department of Veterans Affairs in 1993. The number of inpatient days and outpatient visits over a 4-year period (1991 to 1995) were compared using regression models to control for differences in casemix. RESULTS: Controlling for casemix, patients treated for alcohol dependence had significantly fewer outpatient visits than patients treated for either depression or diabetes. Patients treated for alcohol dependence also had significantly fewer inpatient days than patients treated for depression, but significantly more inpatient days than patients treated for diabetes. Comorbid alcoholism was prevalent among patients treated for depression and diabetes. Comorbid alcoholism increased the number of inpatient days for patients treated for depression or diabetes and increased the number outpatient visits for patients with depression. However, comorbid alcoholism decreased the number of outpatient visits for patients treated for diabetes. CONCLUSIONS: Results suggest that patients with alcohol use disorders should not be singled out as being more costly to treat than patients with other chronic illnesses. These findings are in stark contrast to those from studies comparing individuals with alcohol use disorders to relatively healthy individuals sampled from at-risk populations.     

Familial gastric cancers with Li-Fraumeni Syndrome： A case repast

TO THE EDITOR Although the incidence of gastric cancer has declined somewhat in recent years, it remains one of the most common cancers worldwide[1], and is the most common cancer in East Asian countries such as Korea and Japan[2].In terms of the genetics of gastric cancer, mutations in CDH1 (E-cadberin) have been associated with hereditary diffuse gastric cancer (HDGC). The first germline mutation in CDH1 was reported in a large Maori HDGC family[1],with subsequent corroborations in Western and Asian HDGC families[3-5], CDH1 mutations are believed to be associated with up to 50% of HDGC families[5], but have not been linked with sporadic or intestinal types of gastric cancer[5].     

Thrombocytosis:A paraneoplastic syndrome in patients with hepatocellular carcinoma

AIM:Hepatocellular carcinoma(HCC)patients manifest avariety of paraneoplastic syndromes.Thrombocytosis wasreported in children with hepatoblastoma.The aims of thisstudy were to evaluate the prevalence and dinical significanceof thrombocytosis in HCC patients and its relationships withserum thrombopoietin (TPO).METHODS:We retrospectively reviewed clinical,biochemicaland image data of 1 154 HCC patients.In addition,wemeasured platelet count and serum TPO in HCC patientswith and without thrombocytosis,in patients with cirrhosis,chronic hepatitis and healthy subjects in a cross-sectional study.RESULTS:Thirty-one(2.7%)of 1 154 HCC patients hadthrombocytosis(platelet count≥400 K/mm~3).HCC patientswith thrombocytosis were significantly younger,had ahigher serum α-fetoprotein,higher rate of main portal veinthrombosis,larger tumor volume,shorter survival,andwere less likely to receive therapy than HCC patients withoutthrombocytosis.Multivariate logistic regression analysesshowed that tumor volumes≥30% and serum α-fetoprotein≥140 000 ng/mL could significantly predict thrombocytosis.HCC patients with thrombocytosis had a significantly highermean serum TPO than those without,as well as patientswith cirrhosis,chronic hepatitis and healthy subjects.Platelet count and serum TPO dropped significantly aftertumor resection in HCC patients with thrombocytosis andre-elevated after tumor recurred.Furthermore,the expression of TPO mRNA was found to be more in tumor tissues thanin non-tumor tissues of liver in an HCC patient withthrombocytosis.CONCLUSION:Thrombocytosis is a paraneoplastic syndromeof HCC patients due to the overproduction of TPO by HCC.It is frequently associated with a large tumor volume andhigh serum α-fetoprotein.     

A case of diabetic ketoacidosis associated with Guillain-Barré syndrome

A 64-year-old woman was referred to our center presenting with thirst, malaise, and pain in both legs which occurred one week before admission. She was revealed to have hyperglycemia and diabetic ketoacidosis (DKA). After therapy for diabetic ketoacidosis was started, her blood glucose levels were improved, but urinary ketone body excretion persisted. Laboratory examination indicated a significant impairment of insulin secretion, although anti-GAD and anti-IA-2 antibody were not detected. After admission, she complained about weakness of lower extremities, which spread to her upper extremities. The diagnosis of Guillain-Barré syndrome (GBS) was made based on the nerve conduction study and cerebrospinal fluid analysis. The intravenous immunoglobulin therapy was started, and her muscle weakness showed gradual improvement. Although the possibility that GBS was casually accompanied with DKA could not be completely excluded, we considered that DKA triggered the development of GBS in this case. Although GBS is a rare condition, the present case suggests that GBS should be included in the differential diagnosis of DKA with its atypical course.     

Treatment of Severe Edema in Children with Nephrotic Syndrome with Diuretics Alone — A Prospective Study

Background and objective: Severe edema in children with nephrotic syndrome (NS) may be associated with volume contraction (VC) or volume expansion (VE). Usually, severe edema in children is treated with intravenous (IV) albumin and diuretics, which is appropriate for VC patients. However, in VE patients, this can precipitate fluid overload. The objective of this study was to evaluate treatment of severe edema in NS with diuretics alone.Design, setting, participants, & measurements: Thirty NS patients with severe edema were enrolled in this prospective study in two phases. VC was diagnosed based on fractional excretion of sodium (FeNa) <1%. VC patients received IV albumin and furosemide. VE patients received IV furosemide and oral spironolactone. On the basis of phase 1 observations, FeNa <0.2% identified VC in 20 phase 2 patients.Results: All phase 1 patients had FeNa <1%. Phase 1 patients when reanalyzed based on a FeNa cutoff of 0.2%; it was noted that VC patients had higher BUN, BUN/creatinine ratio, urine osmolality, and lower FeNa and urine sodium compared with VE patients. Similar results were observed in phase 2. VC patients had significantly higher renin, aldosterone, and antidiuretic hormone levels. In phase 2, 11 VE patients received diuretics alone and 9 VC patients received albumin and furosemide. There was no difference in hospital stay and weight loss in VC and VE groups after treatment.Conclusions: FeNa is useful in distinguishing VC versus VE in NS children with severe edema. The use of diuretics alone in VE patients is safe and effective.Idiopathic nephrotic syndrome (NS) is a common renal disease in children. Children with severe edema are usually hospitalized and treated with intravenous (IV) albumin and diuretics. In contrast to adults, children are often more severely hypoalbuminemic and edematous, necessitating hospitalization and IV albumin administration. Albumin is routinely used in children because of (1) low serum oncotic pressure due to hypoalbuminemia, (2) reports of diuretic resistance and decreased efficacy in NS (1–4), (3) increased diuresis when diuretics are given after IV albumin (1,5,6), and (4) a reluctance to treat patients with diuretics only because of concerns about dehydration and increased risk of thromboembolic complications.The routine use of albumin for severe edema (7) in children with NS is based on two mutually exclusive hypotheses proposed for the pathogenesis of edema (8–11). According to the underfill hypothesis, severe hypoalbuminemia decreases intravascular oncotic pressure, leading to circulatory volume depletion and subsequent sodium/water retention (8–11). The overfill mechanism proposes a primary renal defect in sodium excretion leading to sodium/water retention and thereby hypervolemia and edema (8–11). The underfill hypothesis is believed to be more common (7,12). Also, clinically it is not possible to differentiate severely edematous NS patients with intravascular volume expansion (VE) from those with intravascular contraction (VC) (7,12). Hence, the pediatric practitioners are reluctant to only treat the former group of patients with diuretics. The objective of this study was to evaluate the use of diuretics alone for the treatment of severe edema in a subset of children with NS, identified as VE.     

Anti-tumor activity of tanshinone ⅡA in combined with cyclophosphamide against Lewis mice with lung cancer

Objective:To explore the anti-tumor activity of tanshinone ⅡA in combined with cyclophosphamide against Lewis mice with lung cancer and the effect on cellular immune function.Methods:Lewis tumor cells were inoculated suhcutaneously into the right armpit of mice in each group(n=20) to establish Lewis lung cancer mice model.After model establishment,mice in the model group were given normal saline by lavage,qd.Mice in treatment Ⅰ group were given intraperitoneal injection of TanIIA,15 mg/kg,qd.Mice in treatment Ⅱ group were given intraperitoneal injection of CTX,25 mg/kg,qd.Mice in treatment Ⅲ group were given intraperitoneal injections of TanIIA and CTX,in which the administration method of TanIIA was the same as in treatment Ⅰ group,continuously for 2 weeks,and the dosage of CTX was the same as in treatment Ⅱ group,24 h after model establishment,every other day.Mice were sacrificed 2 weeks after establishment.The tumor tissues were collected to calculate the anti-tumor rate.Immunohistochemistry was used to detect the expressions of Bcl-2,Bax,VEGF,Angiostatin,and Endostatin.FCM was used to detect T lymphocyte subsets in spleen and liver of mice.Results:The tumor weight in treatment Ⅰ,Ⅱ,and Ⅲ groups was significantly lower than that in the model group(P0.05).The tumor weight in treatment Ⅲ group was significantly lower than that in treatment Ⅰ and Ⅱ groups(P0.05).The anti-tumor rate in treatment Ⅱ and Ⅲ groups was significantly higher than that in treatment Ⅰ group(P0.05).Bcl-2 expression in the tumor tissues of treatment Ⅰ,Ⅱ,and Ⅲgroups was significantly lower than that in the model group(P0.05),while Bax expression was significantly higher than that in the model group(P0.05).Bcl-2 expression in the tumor tissues of treatment Ⅰ and Ⅱ groups was significantly higher than that in treatment Ⅲ group(P0.05),while Bax expression was significantly lower than that in treatment Ⅲ group(P0.05).CD4~+ and CD4~+/CD8~+ in treatment Ⅰ,Ⅱ,and Ⅲ groups were significantly higher than those in the model group(P0.05).CD4~+ in treatment Ⅲ group was significantly higher than that in treatment Ⅰ and Ⅱ groups(P0.05),while CD4~+/CD8~+ was significantly higher than that in treatment Ⅱ group(P0.05).The comparison of CD8~+ among each group was not statistically significant(P0.05).NK cell activity in treatment Ⅰ,Ⅱ,and Ⅲ groups was significantly higher than that in the model group(P0.05).NK cell activity in treatment Ⅲ group was significantly higher than that in treatment Ⅰ and Ⅱ groups(P0.05).Conclusions:TannA in combined with CTX can down regulate Bcl-2 expression in lung cancer tissues,up regulate Bax expression,inhibit the neovascularization of tumor tissues,and enhance the immunological function,with a significant anti-tumor activity.