Multiple myeloma diagnosed during early pregnancy: a case report

Only five pregnant women with multiple myeloma have been reported in literature. We present the case of one woman with multiple myeloma diagnosed in early pregnancy, who decided to postpone therapy until after delivery. A cesarean section was performed at the 34th week due to the progression of the disease and a normal healthy baby was delivered.     

Primary malignant melanoma of the larynx

Primary malignant melanoma of the larynx is a rare clinical entity. Only 53 cases have been reported in the medical literature to date. This report describes a case of primary malignant melanoma arising in the larynx and diagnosed by histologic examination of an excisional biopsy specimen. The patient was a 53-year-old man with a history of smoking and hoarseness. There was no clinical evidence of other primary malignant melanocytic lesions. Microscopically, the tumor consisted of polygonal-epithelioid cells admixed with more elongated, spindle-shaped cells. The majority of the cells demonstrated dark brown cytoplasmic and nuclear melanin. Marked pleomorphism and abnormal mitoses were also identified. Despite significant ulceration and disruption of the epithelium, in situ malignant melanocytes were recognized within the remaining portion of the epithelium. Immunohistochemical studies were positive for S100, HMB-45, and vimentin, while cytokeratin and iron stains were negative. Based on the clinical and histologic findings, a diagnosis of primary malignant melanoma of the larynx was established.     

DentaScan as an accurate method of predicting mandibular invasion in patients with squamous cell carcinoma of the oral cavity

OBJECTIVE: To determine the diagnostic accuracy of a dental computed tomographic software program, DentaScan, in assessing mandibular bone invasion in patients with squamous cell carcinoma (SCC) of the oral cavity clinically fixed to the mandible. DESIGN: Retrospective chart review. SETTING: Academic tertiary care medical center. PATIENTS: Thirty-six consecutive patients underwent DentaScan imaging of the mandible prior to composite resection for tumor ablation. All patients included in this review had SCC of the oral cavity clinically fixed to the mandible. A final histopathology report specifically addressing the presence or absence of bone invasion was available for each patient. RESULTS: The diagnostic accuracy for DentaScan in this study was as follows: sensitivity, 95%; specificity, 79%; positive predictive value, 87%; and negative predictive value, 92%. CONCLUSION: DentaScan is an accurate method of preoperative evaluation for mandibular invasion in patients with SCC of the oral cavity.     

Combined vaginal and laparoscopic surgical treatment of genito-urinary prolapse

BACKGROUND: A new combined technique for vaginal prolapse and cystocele using minimal access surgery is presented and evaluated. METHODS: Thirty-five patients (mean age 57.1) with genitourinary prolapse (II-IV degree Baden-Walker) without urinary incontinence underwent surgery between January 98 and December 99 with 4-24 months of follow-up (mean 14.6 months). The surgical stages include total vaginal hysterectomy with bilateral adnexectomy, wide opening of the vagina without excessive removal of the vaginal mucosa; the bladder is loosened and the polypropylene mesh (PPM) is lightly fixed to the bladder and stitched to the anterior and posterior vaginal wall. The PPM is introduced into the abdomen and laparoscopically fixed to the sacral promontory with titanium spirals having checked vaginally the right tension of the mesh. Accurately laparoscopic peritonization of the PPM ends the surgical procedure. RESULTS: The operation time was 90'-140' (mean 112') followed by 3-7 days of hospitalization (mean 4.3). Vaginal prolapse and cystocele were corrected in all cases. No surgical complications, de novo urinary incontinence, prolapse recurrence or inconvenience to sexual activity have been observed. There was one erosion of the vaginal wall by the PPM 45 days after the operation. CONCLUSIONS: Initial studies suggest that laparoscopic sacrocolpopexy and cystocele repair with PPM is an effective treatment for genitourinary prolapse. If subsequent studies will confirm these findings, the development of minimal access techniques for genitourinary prolapse will represent a significant surgical advance.     

Multifocal osteolysis with nephropathy

A patient with progressive osteolysis of the carpal and tarsal bones with glomerulonephritis of unusual severity is described. There was a notable absence of osteodystrophy in this and other reported cases who had chronic renal failure.     

Transient synovitis of the hip in children: role of US

Transient synovitis of the hip remains a common diagnostic problem for the clinician. The physical signs are not pathognomonic of the condition, and the classic technical examinations are of little help. Therefore, the authors retrospectively studied the value of hip arthrosonography in 46 children with clinical symptoms suggesting pathologic hip conditions. In 20 of the 21 patients with a final diagnosis of transient synovitis, articular effusion was detected on ultrasound (US). Conventional radiography showed an increased medial joint space in only eight of these patients. Increased echogenicity of the articular fluid was found in both transient synovitis and septic arthritis. The high sensitivity of US in detecting intraarticular fluid was demonstrated by cadaver studies.     

中药贝母类的研究——ⅩⅦ.贝母鳞叶上表皮显微观察

本文对浙贝母Fritillaria thunbergii Miq.等20种贝母的鳞叶上(内)表皮进行了显微观察,发现种间在表皮细胞形状、大小和垂周壁部位角质栓(cuticular peg)的形状,大小和排列等方面有一定区别,可作为新的鉴别依据。全文除描述外,列出检索表,并附主要特征图。     

Clinical significance of anti-Yt(b). Report of a case using a 51chromium red cell survival study

Several published reports have documented the variable survival of Yt(a+) red cells (RBC) in patients with anti-Yt(a) as measured by 51Chromium (Cr)-labeled RBC survival studies. Similar studies with anti-Yt(b) have not been reported. A 51Cr-labeled RBC survival study was performed using Yt(b+) RBCs and a monocyte monolayer assay in a young hemodialysis patient who required chronic transfusion therapy and who had developed anti-Yt(b). The survival of the transfused RBCs was 100 and 93 percent at 1 and 24 hours, respectively, with a half life of 21 days at termination of the study (normal, 28 to 32 days). These results showed no evidence of rapid destruction of the Yt(b+) RBCs, indicating that this patient could be transfused safely with blood from Yt(b+) donors. Long-term survival of the 51Cr-labeled Yt(b+) RBCs was shortened moderately, however, a finding that correlated with a slightly abnormal monocyte monolayer assay test.     

两种麻醉方法对单双肺通气期间能量代谢和呼吸氧价及应激反应的影响

目的:观察胸段硬膜外复合全静脉麻醉和全静脉麻醉对单、双肺通气能量代谢、呼吸氧价和应激反应的影响,比较两者的差异。方法:选择2004-07/2005-01徐州医学院附属医院心胸外科择期行食管癌根治术且需要单肺通气的患者40例,按随机数字表法分为硬膜外复合全静脉麻醉组(n=20)和全静脉麻醉组(n=20),经患者同意并签字后进入试验。分别在单肺通气和双肺通气时进行氧耗量、二氧化碳排出量、能量代谢和呼吸商测定,同时测量肾上腺素、去甲肾上腺素、皮质醇和血糖水平。结果:40例患者全部进入结果分析,无脱落。①在单、双肺通气时硬膜外复合全静脉麻醉组的氧耗量、二氧化碳排出量、能量代谢均高于全静脉麻醉组(P<0.05);两组患者单肺通气时段氧耗量、二氧化碳排出量、能量代谢低于双肺通气时段,但差异无显著性意义(P>0.05)。②在单、双肺通气时硬膜外复合全静脉麻醉组的肾上腺素、去甲肾上腺素、皮质醇和血糖水平均低于全静脉麻醉组(P<0.05);单、双肺通气相比,两组患者肾上腺素、去甲肾上腺素变化差异无显著性意义(P>0.05)。结论:与全静脉麻醉相比,胸段硬膜外阻滞复合全静脉麻醉能够增加胸科手术的氧耗量、能量代谢,减轻应激反应。单、双肺通气期间没有明显差异。