Epiploic appendagitis and omental infarction: pitfalls and look-alikes

Epiploic appendagitis and omental infarction are benign self-limiting conditions that are more frequent than generally assumed. Both disorders frequently mimic symptoms of an abdominal surgical emergency, often leading to clinical misdiagnosis of appendicitis or diverticulitis. Because a misdiagnosis can result in an unnecessary laparotomy, a correct diagnosis is of great importance. Ultrasound and computed tomography can be used to make a reliable diagnosis. This pictorial essay illustrates the various ultrasonographic and computed tomographic appearances of epiploic appendagitis and omental infarction and focuses on their radiologic differential diagnoses and pitfalls. Received: 22 February 2001/Accepted: 18 April 2001     

黄芪治疗急性心肌梗塞的现代研究

介绍中药黄芪制刺在治疗急性心肌梗塞方面现代研究的成果。并对中药学的性味归经及药理学的化学成分作简要概括。就黄芪治疗急性心肌梗塞，从临床应用、疗效原理以及病生理的角度进行纵向综述。     

Extended total arch replacement for type B aortic dissection with ascending aneurysm following healed aortic dissection

We describe a case of type B aortic dissection with large ascending aortic aneurysm occurring 12.8 years after aortic root replacement (Cabrol procedure) in a non-Marfan patient with cystic medial necrosis of the aorta. We have successfully performed an extended total aortic arch replacement using a four-branched graft through the “L-indsion” approach (a combination of a left anterior thoracotomy and upper half median sternotomy). Of note, a histological specimen from the aneurysmal ascending aortic wall revealed “healed aortic dissection” with fibrous tissue replacing the media and intima in addition to multiple foci of cystic medial necrosis.     

Cholesterol atheromatous embolism: an increasingly recognized cause of acute renal failure

BACKGROUND.: Cholesterol atheromatous embolism is a systemic disease resultingfrom cholesterol crystal embolization to many organs, includingthe kidney. Vascular surgery, vascular radiology investigationsand anticoagulation have been identified as inciting factors. METHODS.: Fifteen patients with extensive atherosclerosis, presentingwith simultaneous occurrence of acute renal failure and peripheralischaemic changes were diagnosed as having acute renal failuredue to cholesterol atheromatous embolism. RESULTS.: The patients, 12 men and three women, had an average age of65 years. In one patient, spontaneous occurrence of the diseasewas observed. An inciting factor was identified in 14 patients:aortography in 10, aortic surgery in two, and thrombolysis intwo. Clinical course of acute renal failure was quite variable.Four patients required dialysis; 11 were conservatively managed.All patients had concomitant skin lesions, including digitalmottling, cyanosis and gangrene of the toes, and livedo reticularisof the lower limb and abdomen. Eosinophilia was the most commonlaboratory abnormality. The diagnosis of cholesterol atheromatousembolism was confirmed by tissue examination in eight; in threeit was based on the finding of retinal cholesterol emboli; infourpatients it was made on clinical grounds. Seven patientsdied within 36 months. Death was most commonly from cardiaccauses. CONCLUSIONS.: Since the population at risk for cholesterol embolism is growingand the disease is iatrogenic in origin, we should expect todetect cholesterol embolism with greater frequency as causeof acute renal failure in the future.     

Outcome of a multicenter treatment program including autologous or allogeneic bone marrow transplantation for de novo acute myeloid leukemia

Abstract: The results of an intensive treatment program for patients 16–60 yr of age with de novo acute myeloid leukemia are presented. The patients were given conventional induction treatment with daunorubicin and cytarabine. Patients not entering complete remission (CR) after 1 course of daunorubicin/cytarabine were given 1 course of amsacrine/etoposide/cytarabine. Those entering complete remission received 3 consolidation courses using mitoxantrone, etoposide, amsacrine and cytarabine. One hundred and eighteen patients were enrolled. Complete remission was attained after 1–2 courses in 90 patients (76%). Another 6 patients reached CR after 3–4 induction courses for a total CR rate of 81%. If feasible, patients were offered either allogeneic or unpurged autologous bone marrow transplantation. Twenty-four patients underwent allogeneic bone marrow transplantation; 15 in first remission, 8 in second remission, 1 in early relapse. Thirty patients below 56 yr of age underwent autologous bone marrow transplantation in first remission. The overall probability of survival at 4 yr was 34%, and for patients below 40 yr of age 50%. Leukemia-free survival was 35% for the whole cohort of patients; 52% for patients below 40 yr of age. Patients undergoing allogeneic or autologous bone marrow transplantation in first remission had an overall survival of 86% and 47%, respectively, while the probability of leukemia-free survival in these groups was 87% vs. 40% at 4 yr. The CR rate and long-term results of this intensive treatment program compare favorably with other recent studies using intensive consolidation with allogeneic or autologous bone marrow transplantation or high dose cytarabine.     

肺移植急性排斥反应及其控制实验研究

观察了大鼠实验性肺移植术后急性排斥反应的病理改变。异系间移植术后２ｄ，移植肺内小血管及支气管周围出现单核细胞浸润。４ｄ上述细胞浸润波及肺泡壁，导致肺泡壁增厚，肺内小静脉系及毛细血管管腔变窄，血流不畅。术后６ｄ，血液循环严重障碍处，肺泡完全坏死，环抱素Ａ可使上述排斥反应得到明显抑制。     

偏心圆剥离法在隆乳术中的应用

以往以乳头为圆心的同心圆剥离法常形成假体的移位，使假体的体表轮廓与前方的自然乳房分离，产生“双重乳房”现象。在研究了女性不同体位下不同的乳房形态及总结了以前的经验后，提出了偏心圆剥离的概念。偏心圆手术设计方法：以乳头为圆心，按其内侧、下侧为直径３／５的比例，以外侧、上侧为直径２／５的比例，形成一偏心圆的剥离范围。偏心圆的直径因考虑到假体的不同形态、大小及底面直径，以经中心假体纵截面的周长的１／２再放大２ｃｍ，作为剥离范围的直径。自１９９１年１０月以来已应用了１７６例，无一术后移位现象，也没有固较多地剥离胸大肌内、下侧止点纤维而影响上肢活动。自然乳房并不是静态的圆锥形或半球形，它具有伸缩的组织学特点，又有随体位变动而变化的特点。用偏心圆法剥离，可使置入的假体与前方的自然乳房融为一体，消除“双重乳房”现象，而成为“真实”的乳房。同时也应积极寻找一种与身体组织相容性好的，弹性、比重与女性乳腺较为一致的，假体容量相对恒定的生物性材料。这样隆乳术才可以更广泛地开展。     

Drug Induced Acute Generalized Exanthematous Pustulosis

A 62-year-old woman with diabetic triopathy developed widespread erythematous macules, numerous pustules, and a high fever after she underwent electric coagulation for vitreous hemorrhage. She was administered several drugs at that time. After discontinuation of the drugs, the eruption disappeared, and the fever returned to normal within two weeks. A positive patch test with isepamicin sulfate highly suggested that the symptoms described above were due to drug allergy. Cadralazine, which was positive in the drug lymphocyte stimulation test (DLST), could not be excluded from the causative drugs. A false-positive DLST with ofloxacin was confirmed by an accidental challenge test. To our knowledge, this is the first report of acute generalized exanthematous pustulosis due to isepamicin sulfate and/or cadralazine.