儿童肾细胞癌不典型的影像学表现

肾细胞癌罕见于儿童,通常在儿童晚期被发现。本文报道1例10岁女孩的特殊肾细胞癌。其影像学表现容易导致误诊,但在既往文献中未见报道。因先天性巨输尿管而导致肾皮质变薄,因此当原发性泌尿道上皮疾病(肿瘤或炎性)首次被发现时,肿瘤完全长入排泄腔(临近的输尿管)。萎缩的肾皮质     

Mesenteric infarction secondary to tumor emboli from primary aortic sarcoma. Guidelines for diagnosis and management

Primary aortic tumors are rare, difficult to diagnose, and often fatal. This case and a review of the literature identified aortic tumors as a potential source of emboli leading to acute mesenteric insufficiency. The case showed the efficacy of magnetic resonance imaging in diagnosing and determining the extent and location of an aortic tumor.     

Transcutaneous oxygen measurements in lower extremity ischemia: effects of position, oxygen inhalation, and arterial reconstruction

Transcutaneous oxygen tension (TcPO2) measurement has been successfully applied to the diagnosis and monitoring of patients with peripheral arterial insufficiency. This study was performed to assess the effects of changes in limb position, oxygen inhalation, and arterial reconstruction on TcPO2 values in patients with peripheral vascular disease. In addition, a TcPO2 index (foot TcPO2/chest TcPO2) was compared with the Doppler-derived ankle-to-brachial index (ABI) to determine which was the more effective monitor of the response to revascularization. Foot TcPO2 values of 22 patients with claudication or rest pain were measured before and after vascular reconstruction. TcPO2 increased after revascularization in both groups regardless of limb position or oxygen (O2) administration. The dependent position and O2 inhalation had an additive effect on TcPO2. Preoperative TcPO2 values in patients with rest pain showed the greatest response to the dependent position, increasing from 14 mm Hg to 33 mm Hg at room air and from 21 mm Hg to 53 mm Hg with O2 inhalation. TcPO2 in both patient groups was remarkably enhanced by O2 administration after revascularization. Postoperative supine TcPO2 values measured at room air increased from 50 mm Hg to 124 mm Hg (148%) in patients with claudication and from 40 mm Hg to 109 mm Hg (173%) in patients with rest pain after O2 inhalation. Comparison of the TcPO2 index with the ABI showed that absolute and normalized TcPO2 values are equally effective in monitoring peripheral arterial insufficiency. This study suggests that placing the limb in the dependent position and administering O2 may augment TcPO2 to levels where symptoms may resolve. The response of TcPO2 to O2 inhalation may be an indicator that reflects the response to revascularization.     

Cytology of mucinous carcinoma of breast: a report of 28 cases with histological correlation

Pure mucinous carcinoma (MC) of the breast is a relatively uncommon variant of breast carcinoma with distinctive histological and cytological features. In this study we have analysed fine needle aspiration (FNA) cytological material from 28 cases of MC of breast and correlated the cytomorphological features with histopathology. The 28 patients consisted of 27 females and one male patient. 14 patients were Chinese, 10 were Indian and four were Malay. Their ages ranged from 38 to 90 with a mean at 52 years. The left breast was involved in 17 and the right in 11 cases. The duration of the lump varied from two weeks to 10 years. The cytological picture was characterized by abundant extracellular mucin giving a "sea of mucin" or "whirlpools of mucin" effect, in which were seen floating clusters of tumour cells with relatively bland cytological features. Myxo-vascular fragments were seen in 12 cases. Dissociated tumour cells showed a plasmacytoid appearance with eccentric nuclei. In four cases, the mucin was scanty in amount and the cellularity was high while in two cases, the cellularity was very low. Psammoma bodies were seen in cytological smears in one case. Histological study of excision or mastectomy specimens confirmed all 28 cases to be pure MC. Knowledge of the distinctive cytomorphological appearance of MC would enable correct identification of these lesions as malignant and prompt treatment that could further enhance the survival of these prognostically good breast cancers.     

Reaction to biological drugs: infliximab for the treatment of toxic epidermal necrolysis subsequently triggering erosive lichen planus

Toxic epidermal necrolysis (TEN) is a rare, life‐threatening skin reaction for which there is currently has no standardized treatment, despite its significant mortality. Biological agents such as tumour necrosis factor (TNF)‐α antagonists are emerging as a novel treatment for patients with TEN. We report a 32‐year‐old woman who developed TEN secondary to sulfasalazine, which was treated with infliximab. The infliximab treatment subsequently triggered erosive lichen planus (LP) involving the mouth and vulva. Clinicians should be aware that TNF‐α antagonists can cause LP as a paradoxical complication of treatment.     

Insights from Expanded Adverse Childhood Experiences Screening in a Hospital-Based Outpatient Psychiatry Service

Adverse childhood experiences (ACEs) are associated with poor mental health in adulthood. Comprehensive prevalence data encompassing all 10 ACE questionnaire items has not previously been described in a hospital-based outpatient psychiatric clinic. This study assessed the prevalence of 10 ACEs in such a clinic and correlated ACEs with indicators of case severity. For 252 patients newly evaluated in an urban clinic, a retrospective chart review was completed and data was collected on ACE questionnaire responses, psychiatric, substance-related, and medical diagnoses, psychiatric hospitalizations, suicide attempts, and suicide and violence risk. Patients in the clinic had an average of 3.4 ACEs, higher than national community sample averages of 1.6. The percentages of patients with at least one, two, and four ACEs were 82% (n?=?207), 68% (n?=?172), and 42% (n?=?106) respectively (compared with 61%, 38%, and 15% nationally). ACEs had statistically significant correlations with an increased number of psychiatric diagnoses, substance use disorders, medical illnesses, suicide attempts, and suicide risk level. This study demonstrated that patients seeking psychiatric care from a hospital-based outpatient clinic are likely to be traumatized to a degree far exceeding what is typical in the general population. While a high prevalence of ACEs in a psychiatric population is an expected finding given the literature to date, this is the first study presenting data on the prevalence of ACEs in such a hospital-based community clinic. Additionally this study reinforces prior research correlating childhood adversity and case severity.

     

The effects of prenatal methylmercury exposure on trace element and antioxidant levels in rats following 6-hydroxydopamine-induced neuronal insult

Methylmercury (MeHg) is a metal toxin found commonly in the environment. Studies have shown severe neurotoxic effects of MeHg poisoning especially during pregnancy where it crosses the foetoplacental and the blood brain barrier of the foetus leading to neurodevelopmental deficits in the offspring. These deficits may predispose offspring to neurodegenerative diseases later in life. In this study we investigated the effects of prenatal methylmercury exposure (2.5 mg/L in drinking water from GND 1-GND 21) on the trace element status in the brain of adolescent offspring (PND 28). Total antioxidant capacity (TAC) was measured in their blood plasma. In a separate group of animals that was also exposed prenatally to MeHg, 6-hydroydopamine (6-OHDA) was administered at PND 60 as a model of neuronal insult. Trace element and TAC levels were compared before and after 6-OHDA exposure. Prenatal MeHg treatment alone resulted in significantly higher concentrations of zinc, copper, manganese and selenium in the brain of offspring at PND 28 (p?<?0.05), when compared to controls. In contrast, brain iron levels in MeHg-exposed adolescent offspring were significantly lower than their controls (p?<?0.05). Following 6-OHDA exposure, the levels of iron, zinc, copper and manganese were increased compared to sham-lesioned offspring (p?<?0.05). Prenatal MeHg exposure further increased these trace element levels thereby promoting toxicity (p?<?0.05). Total antioxidant capacity was not significantly different in MeHg and control groups prior to lesion. However, following 6-OHDA administration, MeHg-exposed animals had a significantly lower TAC than that of controls (p?<?0.05). Brain TAC levels were higher in adult male rats than in female rats during adolescence however male rats that had been exposed to MeHg in utero failed to show this increase at PND 74. Prenatal MeHg exposure results in trace element dyshomeostasis in the brain of offspring and reduces total antioxidant capacity. This may reflect a mechanism by which methylmercury exerts its neurotoxicity and/or predispose offspring to further neurological insults during adulthood.