胆囊结石和大肠癌共存时误诊为前者的潜在危险

研究大肠癌和胆囊结石病的相关性。方法：回顾性分析１９９４年６月到１９９６年５月所诊治的２５８例大肠癌病人的临床资料。结果：２５８例大肠癌病人有９例误诊为胆囊结石，并按误诊修正时间分为三类。     

Coexistence of systemic lupus erythematosus and multiple sclerosis: Prevalence,clinical characteristics,and natural history

Objectives

The coexistence of systemic lupus erythematosus (SLE) and multiple sclerosis (MS) in the same individual has rarely been described. Our objective was to report on the prevalence, clinical characteristics, and prognosis of cases fulfilling the criteria for both SLE and MS.

Methods

We utilized existing patient cohorts from the Departments of Rheumatology and Neurology, University of Crete, and screened patients diagnosed with either SLE (n = 728) or MS (n = 819) for features of both diseases. The clinical, laboratory, and neuroimaging findings were assessed.

Results

We identified nine patients who fulfilled the diagnostic criteria for both SLE and MS, corresponding to a prevalence rate of 1.0–1.2% in each cohort. All patients were women, with an average age at SLE diagnosis of 42.1 years (range: 34–56 years). The diagnosis of SLE preceded the development of MS in five patients, with a time lag ≤5 years in four of them. Initial presentation of MS included spinal symptoms in seven patients. All patients had features of mild SLE with predominantly cutaneous, mucosal, and musculoskeletal manifestations. Accordingly, therapeutic decisions were mainly guided by the severity of the neurological syndrome. During the median follow-up of 4 years (range: 1–10 years), three patients remained stable and the remaining experienced gradual deterioration in their neurological status. SLE remained quiescent in all patients while on standard immunomodulatory MS therapy.

Conclusions

Occurrence of both diseases in the same individual is rare, corroborating data that suggest distinct molecular signatures. SLE and MS coexistence was not associated with a severe phenotype for either entity.     

桥本甲状腺炎与亚急性甲状腺炎共存(二例报告)

报告两例桥本甲状腺炎与亚急性甲状腺炎 (亚甲炎 )共存的罕见病例 ,诊断依靠临床特征、实验室检查和组织病理学的综合分析。提示典型亚甲炎或病理诊断的亚甲炎伴甲状腺自身抗体滴度持续性显著升高者应怀疑两病共存。     

COEXISTENCE OF FOS-LIKE PROTEIN IN TYROSINE HYDROXYLASE-LIKE IMMUNOREACTIVE NEURONS IN THE HINDBRAIN OF ARTS FOLLOWING PERIPHERAL ELECTRICAL STIMULATION

In the present study we have found that proto-oncogene c-fos protein can expressin the noradrenergic neurons of rat hindbrain following peripheral electrical stimulation. Ratswere given peripheral electrical stimulation via thin stainless steel pins inserted into the pointsnear knee joint (S36) and ankle joint (Sp6) which mimic the manipulation of electroacupuncture(EA) performed in humans. Animals were perfused for double staining immunohistochemistry 2hafter the termination of EA. In rats subjected to EA stimulation Fos-like protein was found in thetyrosine hydroxylase (TH)-like immunoreactive neurons in rat hindbrain. The Fos and TH coex-isting neurons were distributed in the locus coeruleus, solitary tract nucleus, ventrolateral medul-la, periaqeductal gray, as well as superior colliculus. The percentage of the coexisting neuronscompared with the total number of neurons containing Fos-like protein in these nuclei rangedfrom 6% to 32%. The results suggest that the noradrenergic neurons in these regions may be ac-tivted by acupuncture stimulation.     

Immunolocalization of putative neurotransmitters innervating autonomic regulating neurones of cat ventral medulla

This study investigated possible sites of contact of nerve fibers containing a range of putative neurotransmitter substances onto neurons in the cat ventral medulla oblongata concerned with autonomic, particularly cardiovascular, regulation. The parasympathetic preganglionic neurons of the nucleus ambiguus were identified by retrograde horseradish peroxldase tracing from the vagus nerve, and the groups of neurons in the Al and C1 cell areas and the raphe nucleus by cafscholamine enzyme or 5-hydroxytryptamins (5-HT) inurnxuohistoduemistry, respectively. Immunoreactive (-ir) nerve fibers and terminals in the vicinity of these neurons were visualized by subjecting the sections to a dual-staining technique using a brown peromddase-diaminobenzidine reaction product and a blue alkaline phosphatese-Fast blue reaction product: By employing monochrome photography with combinations of blue and orange-red filters, it was possible to discriminate neural elements displaying one or the other reaction product, or colocalization of reaction products. The results revealed the presence of calcitonin gene-related peptide (CORP) and galanin (GAL)ir in some motonsurons of the nucleus ambiguus, but not in those innervating the heart via the cardiac vagus nerve. The latter group of parasympathetic efferent neurons were found to be densely innervated by fibers innnrunoreactive for dopamine β-hydroxylase (DBH, indicating noradrenalineL ghrcine (GLY), γ-aminobutyric acid (GABA), 5-HT, enkephalin (ENK, neuropeptide Y (NPY), substance P (SP), and i hormone (TRK and, to a lesser extent, by other netropep ide-ir fibers. The came cells of the rostal C1 and caudal A1 groups showed a broadly similar pattern of innervation, most noticeably by fibers immurwreactive for DBH, GABA, 5-HT, cholecystokinin (CCIQ, CGRP, ENK, GAL, NPY, and SP. The 5-HT-ir neurons of the raphe nucleus, some also containing SP, TRH, ENK, or aorticotropin-releasing factor (CRF)-ir, were most prominently innervated by terminals containing DBH, GABA, CCK, ENK, NPY, TRH, somatostatin (SRIF), and vasoactive intestinal polypeptide (VIP)-ir. Although the proof that these groups of neurons receive functional synaptic contacts from the immunoreactive fibers awaits furtis ultrastructural studies, the results do suggest that a wide range of putative transmitters may influence the activity of efferent neurons in the cat medulla controlling autonomic functions.     

Clinical characteristics of pulmonary cryptococcosis coexisting with lung adenocarcinoma: Three case reports

BACKGROUNDPulmonary cryptococcosis (PC) is an invasive fungal disease caused mainly by Cryptococcus (C.) neoformans or C. gattii. It may be present in immunocompetent or immunocompromised patients. The radiographic features of PC vary, and the most common computed tomography manifestation is the presence of solitary or multiple pulmonary nodules or masses distributed in the outer zone of the lung field. The appearance of nodular or mass-like PC on computed tomography scans resembles that of primary or metastatic lung cancers, and differential diagnosis is sometimes difficult. The coexistence of PC and malignant tumors is rarely observed. CASE SUMMARYThis paper reports three cases of PC combined with lung adenocarcinoma diagnosed by video-assisted thoracic surgery lung biopsy, which were successfully managed by early diagnosis and treatment. CONCLUSIONThe present case report might serve as a reminder not to neglect PC coexisting with adenocarcinoma. Early diagnosis and treatment lead to a better prognosis.     

Bacterial profiles of oral streptococcal and periodontal bacterial species in saliva specimens from Japanese subjects

Objective

Recent developments in molecular biological techniques have increased understanding of the distribution of oral bacterial species in clinical specimens, though few investigations have been conducted to simultaneously detect oral streptococcal and periodontal species in the same specimens. The purpose of the present study was to investigate the distribution and correlation of 6 oral streptococcal and 6 periodontal species in saliva specimens taken from children and their mothers.

Design

Seventy-four pairs of children and their mothers were approved to participate in this study. Saliva specimens were collected and bacterial DNA extracted, which was subjected to PCR analyses using species-specific sets of primers. The combinations of species able to be detected simultaneously were determined by statistical analyses.

Results

Streptococcus sobrinus and Porphyromonas gingivalis were detected more often in the mothers than the children. Streptococcus mutans, Streptococcus sanguinis, and Streptococcus oralis were detected simultaneously in a significant number of specimens, while the presence of Campylobacter rectus was correlated with the presence of at least one of the red complex species (P. gingivalis, Treponema denticola and Tannerella forsythensis). On the other hand, no correlation was shown between the rates of detection of oral streptococcal and periodontal species.

Conclusions

Our results indicate that among streptococcal and periodontal species, several are able to coexist in saliva, while the presence of both does not have an influence on each other.     

Genetic studies in a patient with X-linked retinoschisis coexisting with developmental delay and sensorineural hearing loss

Background: In this study, we present a juvenile retinoschisis patient with developmental delay, sensorineural hearing loss, and reduced axial tone. X-linked juvenile retinoschisis (XLRS) is a retinal dystrophy, most often not associated with systemic anomalies and also not showing any locus heterogeneity. Therefore it was of interest to understand the genetic basis of the condition in this patient.

Materials and methods: RS1 gene screening for XLRS was performed by Sanger sequencing. Whole genome SNP 6.0 array analysis was carried out to investigate gross chromosomal aberrations that could result in systemic phenotype. In addition, targeted next generation sequencing (NGS) was employed to determine any possible involvement of X-linked syndromic and non-syndromic mental retardation genes. This NGS panel consisted of 550 genes implicated in several other rare inherited diseases.

Results: RS1 gene screening revealed a pathogenic hemizygous splice site mutation (c.78+1G>T), inherited from the mother. SNP 6.0 array analysis did not indicate any significant chromosomal aberrations that could be disease-associated. Targeted resequencing did not identify any mutations in the X-linked mental retardation genes. However, variations in three other genes (NSD1, LARGE, and POLG) were detected, which were all inherited from the patient’s unaffected father.

Conclusions: Taken together, RS1 mutation was found to segregate with retinoschisis phenotype while none of the other identified variations were co-segregating with the systemic defects. Hereby, we infer that the multisystemic defects harbored by the patient are a rare coexistence of XLRS, developmental delay, sensorineural hearing loss, and reduced axial tone reported for the first time in the literature.     

Coexistence of hepatocellular carcinoma and gastrointestinal stromal tumor： A case report

Malignant gastrointestinal stromal tumors(GIST)are raremesenchymal tumors originating from the wall of thegastrointestinal tract.Their coexistence with other tumorsoriginating from other germ layers is unique.We havereported a case of a 63-year-old GIST patient presentingas an epigastric mass associated with hepatic tumor.Histologically,the mesenteric tumor was composed ofspindle cells showing both neural and smooth muscledifferentiation.Immunohistochemical examinationshowed positive staining for CD117,vimentin,S-100,and SMA,while CD34 antigen was negative.The hepatictumor was diagnosed as hepatocellular carcinoma(HCC).To the best of our knowledge,this is the first case ofGIST and HCC coexistence.The rarity of the case,however,should not lead to ignoring such a possibility indifferential diagnosis.     

《医保目录》与《基本药物目录》共存问题的探讨

目的:探讨《医保目录》与《基本药物目录》的共存问题。方法:比较分析了2009版《医保目录》与2009版《基本药物目录》的适用范围、作用、制定依据、执行效力的异同。结果与结论:2009版《基本药物目录》缓解了《医保目录》与《基本药物目录》二者长期共存的矛盾,但二者短期内难以并存。