The pattern of functional and organic disorders in an Asian gastroenterological clinic

Abstract The aim of the present study was to determine the pattern of structural and functional disorders encountered in an Asian gastroenterological clinic and to compare this pattern with findings from Western centres. Consecutive new patients (totalling 2384) attending the clinics of two consultant gastroenterologists were studied. Of these, 2141 suffered from gastroenterological problems. One thousand and sixty-three (49.6%) had structural diseases, the commoner ones being liver disease, peptic ulcer, malignancy, haemorrhoids and gallstones. The remainder who were found to have no structural disease ( n = 1078; 50.4%) were deemed to have functional disorders including non-ulcer dyspepsia, irritable bowel, simple constipation and functional diarrhoea. The proportions of functional and structural disease were similar to those in the West. Major differences included a higher frequency of hepatoma and a lower frequency of inflammatory bowel disease and gastro-oesophgeal reflux in the present series.     

Sarcomatoid carcinoma associated with chronic empyema and early lung and pleural metastases: A case report

Introduction:The relationship between chronic empyema and malignant tumors, most of which are lymphoma, has been recognized for many decades. Sarcomatoid carcinoma associated with chronic empyema is extremely rare, may metastasize to other organs in the early stage, and rapidly progresses to death. As far as we know, this was the first case report on sarcomatoid carcinoma associated chronic empyema.The patient''s main concerns and important clinical findings:A 59-year-old man presented to our hospital with a 9-year history of chronic empyema and a chief complaint of left chest wall pain for 5 months. The diagnostic contrast-enhanced computed tomography (CT) showed a large irregular soft tissue mass located on the left lower hemithorax at the margin of the empyema cavity extending to the adjacent chest wall and lung parenchyma. In addition, CT revealed pleural and pulmonary metastases surrounded by ground glass opacity.The main diagnosis, therapeutics interventions, and outcomes:The patient underwent CT guided percutaneous core needle biopsy (PCNB). The histopathological evaluation showed carcinomatous proliferation of pleomorphic spindle cells with extensive necrosis. Immunohistochemically, tumor cells were positive for cytokeratin and vimentin. The final histopathological diagnosis was sarcomatoid carcinoma underlying chronic empyema. The tumors showed rapid progression on serial simple radiography. Palliative treatments were performed, but the patient still developed severe dyspnea and died shortly after on day 16.Conclusion:Sarcomatoid carcinoma can occur very rarely as a complication of chronic empyema, and is more aggressive than usual. Early detection of developing malignancy during the follow-up of chronic empyema is an important factor for patient prognosis.     

Small bowel sarcoma: A rare case report

Sarcoma of the small bowel is an extremely rare type of small bowel malignancy and represents around 10 per cent of small bowel cancers. Usually asymptomatic, patients can present with chronic abdominal distention with pain and/or weight loss. Most pathologists now refer to small bowel sarcomas (SBS) as gastrointestinal stromal tumours as they are mesenchymal neoplasms believed to be derived from the interstitial cells of Cajal in the gastrointestinal tract. SBS can be highly vascular and commonly ulcerate and/or bleed. They tend to be aggressive and have a poor prognosis. Surgery is the treatment of choice for SBS, with definitive diagnosis usually made postoperatively with the aid of histopathology. We would like to highlight the importance of careful intra-operative examination of an unknown small bowel (SB) mass, which can give the surgeon clues to the type of tumour present. This case report aims to demonstrate this important process: recognising SBS intra-operatively will aid the surgeon with performing the appropriate resection as minute omental metastasis can be present with SBS; in such cases an omentectomy during the laparotomy is recommended. In institutions where available, intra-operative radiotherapy is ideal.     

常见消化系统恶性肿瘤与2型糖尿病关系的临床研究

目的：探讨消化系统恶性肿瘤与糖尿病之间的关系。方法对我院2012年1月—2013年4月确诊的20例胰腺癌、51例肝癌、42例胃癌和63例结直肠癌患者2型糖尿病患病率以及各项指标数据进行统计,并随机抽查同期本地某社区年龄、性别等条件相似的180例普通居民作为对照组,收集数据并进行统计分析。结果消化系统恶性肿瘤患者糖尿病患病率为对照组的2.6倍;各种消化系统恶性肿瘤患者的糖尿病患病率按高低分别为：胰腺癌患者组6例（30.0%）,肝癌患者组11例（19.6%）,胃癌患者组6例（16.7%）,结直肠癌患者组10例（15.9%）,除了胃癌患者,其余各种恶性消化系统肿瘤糖尿病的患病率均高于对照组（P<0.05）。在消化系统恶性肿瘤患者中,合并糖尿病患者的FPG、HbA1C、CA199较未合并糖尿病患者偏高（P<0.05）。结论糖尿病与恶性消化系统肿瘤的发病存在相关性。     

伊曲康唑预防血液肿瘤患者粒细胞减少期并发真菌感染的疗效观察

目的:探究应用伊曲康唑口服液预防血液肿瘤患者化疗后粒细胞减少期并发真菌感染的效果.方法:将62例化疗后中性粒细胞减少的血液肿瘤患者随机分为真菌感染预防用药组和对照组,其中预防用药组患者预防性地服用伊曲康唑口服液,而对照组患者未接受任何预防性抗真菌药物治疗.观察并比较2组患者真菌感染的发生率和严重程度.结果:31例服用伊曲康唑口服液患者中,仅2例发生真菌感染,真菌感染率仅为6.5%,而对照组31例中,8例并发真菌感染,包括3例深部真菌感染,真菌感染率为25.8%,明显高于预防用药组(P<0.01),而且2组患者并发真菌感染的病原菌存在明显差异.结论:预防性应用伊曲康唑口服液能有效降低血液肿瘤患者化疗后粒细胞减少期真菌感染的概率.     

Sacral inflammatory pseudotumor revealed by paraneoplastic syndrome

There is still debate on whether inflammatory pseudotumor should be considered benign or malignant. This lesion has only been reported twice in bone, apart from cases complicating foreign body reaction to joint replacement arthroplasty. We report here a third case, localized at the sacrum. A 31-year-old man had inflammatory dorsalgia and polyarthralgia without synovitis but with fever, asthenia, and erythema nodosa. Biological tests and X-rays were not informative, but technetium scintigraphy revealed a high level of left sacroiliac tracer binding. Several nonsteroidal anti-inflammatory drugs and sulfasalazine treatment were given over 3 months but ineffective. Pelvic magnetic resonance imaging showed an osteolytic tumor of the sacrum. Biopsy suggested a malignant fibrosarcoma, but complete evaluation after surgical resection demonstrated an inflammatory pseudotumor. All clinical symptoms disappeared within a few days after surgery, which is suggestive of a paraneoplastic syndrome. No relapse has occurred after 4 years.     

Treatment of Hematologic Malignancies with Alternate Hemibody Irradiation Combined with High-Dose Chemotherapy: A Single-Center Experience

The objective of this study was to evaluate the clinical outcome of the treatment of hematologic malignancies with alternate hemibody irradiation (AHBI) combined with high-dose chemotherapy. Seventeen patients with hematologic malignancies were treated with AHBI combined with high-dose chemotherapy. Following high-dose chemotherapy, upper hemibody irradiation (UHBI) and lower hemibody irradiation (LHBI) were given sequentially in a dose of 6 to 9 Gy. UHBI was given 14 days (range, 12-22 days) after high-dose chemotherapy, and LHBI was performed 23 days (range, 7-34 days) after UHBI. Meanwhile, we treated a control group of 14 patients with acute lymphoblastic leukemia (ALL) with autologous hematopoietic stem cell transplantation (AHSCT). Hematopoietic reconstitution was observed in all of the patients. The median follow-up period was 927 days (range, 428-1446 days). The 3-year probabilities of disease-free survival (DFS) were 52.38% +/- 13.47% for the patients in complete remission who underwent AHBI. No patient died of AHBI-related toxicity. The 3-year DFS rates for the 2 groups of patients with ALL were not significantly different (47.73% +/- 17.55% in the AHBI group and 53.88% +/- 14.08% in the AHSCT group; P > .05). AHBI combined with high-dose chemotherapy is a feasible approach for patients with hematologic malignancies and has the advantages of a desirable effectiveness, low costs, simple operation, and acceptable side effects.     

A COMPARATIVE STUDY OF T-CELL DEPLETED AND NON-DEPLETED MARROW TRANSPLANTATION FOR HEMATOLOGICAL MALIGNANCY

Sixteen patients with hematological malignancy received cyclophosphamide (120 mg/kg), fractionated total body irradiation (12 Gy), oral cyclosporin, and an HLA-identical sibling marrow transplant depleted of T cells by incubation with the monoclonal antibody anti-HuLy-m1 (CD2) and rabbit complement with (five patients) or without (11 patients) anti-HuLy-m8 (CD8). These 16 patients were compared historically to 84 patients with hematological malignancy receiving cyclophosphamide (120 mg/kg), fractionated total body irradiation (12 or 14 Gy), oral cyclosporin, and unmanipulated HLA-identical sibling marrow, for parameters of engraftment and graft-versus-host disease (GVHD). Graft failure occurred in one of the 16 T-cell depleted recipients and in one of the 84 non-depleted recipients. Engraftment was slightly but significantly slower in the T-cell depleted group and bacterial infections significantly more, frequent and severe than in the unmanipulated group. There was a suggestion that the severity of acute GVHD was reduced in those receiving T depleted marrow. Randomized trials will be necessary to determine if marrow T-cell depletion results in superior long-term leukemia-free survival.     

糖皮质激素受体水平与造血系统恶性肿瘤疗效关系的探讨

研究７６例造血系统恶性肿瘤的ＧＣＲ水平，其中淋巴瘤２５例，急淋１１例，急粒１８例，慢粒１３例，多发性骨髓瘤９例。结果显示：急淋病人ＧＣＲ水平与化疗疗效密切相关，急粒、慢粒、多发性骨髓瘤、淋巴瘤病人ＧＣＲ水平与化疗疗效无相关性。