Turner综合征自发性青春发育分析

目的探讨先天性卵巢发育不全综合征（Turnersyndrome,TS）患儿自发的青春发育与染色体核型及性激素水平之间的关系。方法30例Turner综合征患儿进行染色体检查,评估第二性征及性腺发育情况,检测性激素水平。结果染色体核型分4组,第1组45,XO,10例;第2组嵌合型,9例;第3组x染色体结构畸变,10例;第4组伴有Y染色体,1例。30例患儿随访至15周岁,其中10例出现不同程度的自发性青春发育,20例呈无性发育,4组患儿中以嵌合型TS出现自发青春发育几率最大。有青春发育患儿的性激素水平与无性发育患儿的性激素水平有显著差异。结论Turner综合征患儿自发性青春发育与染色体核型及性激素水平有密切相关性。     

电视胸腔镜与传统开胸手术治疗外伤性血气胸的效果比较

目的 比较电视胸腔镜(VATS)和传统开胸手术治疗外伤性血气胸的临床效果.方法 血气胸患者41例随机分为实验组和对照组,对照组26例,采用传统开胸手术方法;实验组15例,采用VATS治疗,对两组患者一般临床资料、术中出血量、手术时间、术后胸管放置时间、术后引流量等进行比较.结果 41例患者均无手术死亡、二次开胸止血,术后均未呼吸机辅助呼吸.实验组术中出血量[(176.5 ±78.5) ml]明显少于对照组[(401.3±90.7)ml],手术时间[实验组(64.7-±21.3) min,对照组(129.4±30.3) min]、术后胸管放置时间[实验组(2.3±0.9)d,对照组(4.5±1.0)d]、住院时间[实验组(9.1±2.1)d,对照组(12.7±2.2)d]及术后并发症发生率等方面均少于对照组,两组比较差异有统计学意义(P＜0.05).结论 VATS治疗外伤性血气胸与传统开胸手术比较,诊断快速准确,安全可靠,并发症少.     

Spontaneous rupture of metastatic α-fetoprotein-producing gastric cancer of the liver

An 80-year-old man was admitted to our hospital because of the rupture of the liver. Laboratory data showed iron-deficiency anemia, although there was no liver dysfunction. A computed tomography scan showed large liver tumor with intraperitoneal hemorrhage, and since a serum level of α-fetoprotein (AFP) was extremely high, we initially suspected a rupture of hepatocellular carcinoma (HCC). Transarterial embolization was performed to stop bleeding from the tumor, followed by an endoscopic examination that revealed advanced gastric cancer. Histological analysis revealed that both the gastric and the hepatic tumors were moderately to poorly differentiated adenocarcinoma, as well as that both tumors were immunohistochemically positive for AFP. Finally, we diagnosed AFP-producing gastric cancer associated with liver metastasis. Rupture of metastatic liver cancer is rare, and accordingly, distinction from HCC is important, particularly for the cases of AFP-producing gastric cancer.     

试管婴儿双胎及自然受孕双胎临床分析

目的分析试管婴儿双胎与自然受孕双胎产妇和新生儿的临床结局。方法收集2010年1月至2014年4月106例试管婴儿双胎妊娠(试管组)与256例自然受孕双胎妊娠(对照组)的产妇年龄、妊娠周期、分娩方式、妊娠期合并症、新生儿体格发育、新生儿出生缺陷及新生儿围生期疾病等临床资料,并进行统计学比较分析。结果试管组产妇平均年龄(32±4岁)高于对照组(28±4岁,P0.05)。试管组产妇妊娠期高血压及妊娠期糖尿病发生率均显著高于对照组(均P0.05)。两组新生儿在体格发育、出生缺陷疾病发生率、围生期疾病发病率及病死率等方面比较差异均无统计学意义(均P0.05)。结论本研究显示试管婴儿双胎与自然受孕双胎围生期结局无明显差异;试管婴儿双胎妊娠的产妇在妊娠期需密切关注血压及血糖的波动情况。     

Spontaneous coronary artery dissection: A single-center case series and literature review

Background

Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS). Better recognition and diagnosis has raised awareness of this condition. However, the pathophysiology of SCAD and its prognosis are still little understood. We aimed to investigate the characteristics and prognosis of patients with SCAD, and subsequently performed a review of literature.

高频振荡通气治疗新生儿气胸的疗效观察

目的：探讨临床有效治疗新生儿气胸的可靠方法,为新生儿气胸的临床研究和治疗实践提供参考和借鉴依据。方法本研究选取2010年12月至2013年12月绵阳市人民医院收治的新生儿气胸患儿92例,随机分成常规呼吸机组和高频呼吸机组,每组46例,分别实施传统常频通气治疗和高频振荡通气治疗。观察并比较两组治疗前后的氧合指数值和动脉/肺泡氧分压比值。结果高频呼吸机组治疗后24 h和48 h氧全指数水平均显著优于常规呼吸机组,差异有统计学意义（ t=3.8544,5.7208,P均<0.05）;高频呼吸机组治疗后24 h和48 h的动脉/肺泡氧分压比值均显著优于常规呼吸机组,差异有统计学意义（ t=6.3553,6.3803,P均<0.05）。结论在临床针对新生儿气胸患儿实施治疗的实践过程中,与传统常频通气治疗方法比较,采用高频振荡通气治疗新生儿气胸的临床治疗效果显著,是临床针对新生儿气胸患儿实施治疗的理想选择之一。     

Spontaneous regression of Merkel cell carcinoma: A case report and review of the literature

INTRODUCTIONMerkel cell carcinoma (MCC) is a rare and highly aggressive primary cutaneous neuroendocrine carcinoma, most often occurring in the elderly. Recurrence is frequent and in 40% of cases regional and distant metastases develop. Despite this, there have been reports of spontaneous regression. We report the first case of MCC with primary complete spontaneous regression of the nose in an 86-year-old woman following an incisional biopsy.PRESENTATION OF CASEAn 86-year-old woman presented with a violaceous lump on the left side of the nose measuring 25 × 25 mm. Incisional biopsy of the lesion showed MCC and immunohistochemistry confirmed diagnosis. Following an 8-week period the lesion completely disappeared and histology did not show any residual MCC but immunohistochemistry demonstrated a mixture of T and B cells.DISCUSSIONComplete spontaneous regression (CSR) is rare. The literature documents 22 similar cases of CSR of MCC. From this case report and previous literature the most likely reason for regression is a T-cell mediated immune response.CONCLUSIONTo the best of our knowledge, this is the first described case of MCC with primary CSR of the nose. Exact mechanism of regression remains unclear. Further research is needed in identifying pathway of immune response and possible immunotherapy as a cure.     

HCV-specific lymphocyte responses in individuals with positive anti-HCV but negative HCV-RNA

BackgroundHepatitis C virus (HCV) status cannot be reliably predicted in anti-HCV positive/HCV-RNA negative individuals who may either have recovered spontaneously or have a false-positive test due to antibody cross-reaction. Investigating T lymphocyte responses in individuals with different HCV status may help understand the cellular immune mechanisms underlying spontaneous recovery, treatment response, and chronicity.ObjectiveWe aimed to determine whether anti-HCV positive, HCV-RNA negative individuals are truly spontaneous recoverers from acute HCV infection.Study designWe used enzyme-linked immunosorbent spot (ELISPOT) assay to compare HCV-specific lymphocyte response among anti-HCV positive/HCV-RNA negative individuals, patients with sustained virological response to interferon-γ/ribavirin treatment, and patients with chronic HCV infection.ResultsWe found that 83% of anti-HCV positive/HCV-RNA negative individuals without a past medical history of acute icteric hepatitis had an HCV-specific T lymphocyte response in peripheral blood. Lymphocyte responses in these individuals were similar in magnitude to treatment responders unlike patients with chronic HCV whose virus-directed immunity was significantly suppressed.ConclusionsDetection of HCV-specific T lymphocyte responses using ELISPOT is a feasible method to ascertain past asymptomatic acute HCV infection.     

A case of invasive Langerhans cell histiocytosis localizing only in the lung and diagnosed as pneumothorax in an adolescent female

In infants, Langerhans cell histiocytosis (LCH) is associated with poor clinical outcomes as Langerhans cells invade and damage multiple organs, a presentation that is different from that in adults. Here, we present a case of a 15-year-old female who visited ourclinic complaining of right chest pain and dyspnea. She was diagnosed with right pneumothorax by chest X-ray. Chest computed tomography showed multiple cystic changes in the bilateral lung. Additionally, bullous lesions occupying the upper lobe and multiple white tiny nodules on the surface of the lung were observed by thoracoscopy. These nodules comprised proliferating atypical CD1a/S-100-positive cells invading the pulmonary parenchyma, leading to the diagnosis of LCH. Because of the extensive invasion into the pulmonary parenchyma, chemotherapy was administered. This case of LCH was unique in that the age of onset was atypical and the tumor cells occupied a single organ, despite their malignant behavior.     

肺大疱患者自发性气胸临床特点及复发影响因素分析

目的：分析肺大疱患者自发性气胸复发现状和影响因素。方法选取我院2010－03～2014－02间收治的48例经CT证实存在肺大疱的自发性气胸患者为研究对象,对本组患者的临床资料进行回顾性分析。所有患者首次发病确诊后均卧床休息,常规给予吸氧、止咳等基础治疗,合并肺部感染者加用抗生素控制感染。肺压缩面积＜20％者5例,气胸均自行吸收;肺压缩面积＞20％者43例行胸腔闭式引流术。仍有9例经以上治疗效果不佳,行手术治疗。结果对所有患者随访至2014年8月,随访时间均在半年以上。共有14例患者气胸复发,气胸的复发率为29．2％。其中6例为1次复发,4例为2次复发,3例为3次复发,1例为4次复发。复发的患者中,最终有2例接受胸腔镜手术,1例行开胸手术。认为肺大疱患者自发性气胸复发率高,气胸发作胸闷症状多见,各种合并存在的肺内外基础病,是气胸复发的重要影响因素。结论对复发性气胸患者,正确评估患者手术耐受能力,及时外科手术处理,可降低自发性气胸发生或复发的概率,也是改善患者生活质量的有效措施。