Syringocystadenocarcinoma papilliferum in a linear nevus verrucosus

Syringocystadenocarcinoma papilliferum (SCACP), the malignant counterpart of syringocystadenoma papilliferum (SCAP), is a rare form of adenocarcinoma of the skin. Only 11 well‐documented case reports of SCACP have been published so far. An 83‐year‐old woman with a linear nevus verrucosus (LNV) on her right arm had a history of a nodule arising within this nevus that was diagnosed as SCAP by skin biopsy 7 years earlier. Since then, the nodule had enlarged gradually and formed an exophytic tumor with a moist surface, measuring 3 × 2.5 cm. The tumor was excised and studied by histologic examination. Although histologically the overall architecture of the tumor still resembled SCAP, transition to SCACP was obvious by the presence of areas of cytonuclear atypia, increased proliferative activity and infiltrative growth. The edges of the excised ellipse flanking the tumor showed typical microscopic features of LNV, but no organoid components of nevus sebaceus (NS).We report the 12th case of SCACP, the first case of SCACP on the arm and the first case of SCACP arising from pre‐existing SCAP, in what appeared to be an epidermal nevus. Hoekzema R, Leenarts MFE, Nijhuis EWP. Syringocystadenocarcinoma papilliferum in a linear nevus verrucosus.     

Dystrophia myotonica and pregnancy]

We describe the maternal and neonatal complications of pregnancy in two patients with myotonic dystrophy. The disease leads to an increased spontaneous abortion rate, hydramnios, prolonged first and second stages of labour, retained placenta, postpartum haemorrhages and anaesthetic sensitivity in the mother. The neonatal problems are caused by the congenital form of the disease. The major clinical features of congenital myotonic dystrophy are bilateral facial weakness, hypotonia, neonatal distress, feeding difficulties, talipes, tent-shaped mouth, mental retardation and delayed motor development. Relatives of a known myotonic dystrophy patient should be advised to let themselves be examined for this disease. If the disease is diagnosed, information should be given regarding possibilities for prenatal diagnosis. Pregnancy in myotonic dystrophy patients should be monitored by a gynaecologist. Labour has to take place in a hospital with intensive care facilities for mother and child.     

Fever and neutropenia in cancer patients: the diagnostic role of cytokines in risk assessment strategies

Cancer patients treated with chemotherapy are susceptible to bacterial infections. Therefore, all neutropenic cancer patients with fever receive standard therapy consisting of broad-spectrum antibiotics and hospitalization. However, febrile neutropenia in cancer patients is often due to other causes than bacterial infections. Therefore, standard therapy should be re-evaluated and new treatment strategies for patients with variable risk for bacterial infection should be considered. This paper reviews the changing spectrum of microorganisms and resistance of microorganisms to antibiotics in infection during neutropenia and discusses new strategies for the selection of patients with low-risk for bacterial infection using clinical and biochemical parameters such as acute phase proteins and cytokines. These low-risk patients may be treated with alternative therapies such as oral antibiotics, early discharge from the hospital or outpatient treatment.     

那屈肝素钙治疗不同发病时间的急性脑梗死

目的 :研究那屈肝素钙治疗不同发病时间脑梗死的疗效。方法 :5 0例发病 12h以内的脑梗死病人 ,随机分为治疗A组和对照A组各 2 5例 ;6 0例发病 12～ 4 8h ,随机分为治疗B组和对照B组各 30例。以上各组均予以丹参注射液 2 0mL +氯化钠注射液 2 5 0mL ,ivdrip ,qd。治疗组加用那屈肝素钙4 10 0IU ,sc ,q 12h。 4组疗程均 10d。治疗前、治疗后 1mo和 3mo测定病人神经功能缺损程度评分(NFDS)和日常生活活动能力评分 (ADL)。结果 :1mo和 3mo后 ,治疗A组和B组NFDS为 10± 4 ,5± 4和 13± 6 ,8± 3;与对照A组 (13± 5 ,10± 5 )和B组 (14± 7,12± 4 )比较 ,P <0 .0 5或P <0 .0 1。ADL评分和血液流变学指标各组均有改善 ,但以治疗A组尤为明显 ,P <0 .0 5或P <0 .0 1。结论 :那屈肝素钙能有效治疗急性脑梗死 ,早期应用效果更佳