Objective To elucidate the clinical features and treatment of parapneumonic effusions ( PPE) . Methods Ninety-seven patients were analyzed retrospectively in Guangzhou First Municipal People’s Hospital fromJanuary 2004 to July 2008. The data of 54 patients with complicated parapneumonic effusion ( CPPE) and 9 cases with empyema were compared with 49 patients with tuberculosis pleural effusions. Results Of 97 cases, 34 patients with uncomplicated parapneumonic effusion ( UPPE) were treated with antibiotics only, whose hospitalization time was ( 14. 8 ±7. 6) days, and 27 cases were cured ( 79. 4% ) . Of 54 CPPE patients, 42 were treated with antibiotics and pleural space drainage with central venous catheter, whose hospitalization time was ( 21. 7 ±13. 0) days, and 32 were cured ( 76. 2% ) . Another12 CPPE patients were treated with interapleural urokinase and drainage from the chest tube, whose hospitalization time was ( 22. 5 ±9. 3) days, and 8 were cured ( 66. 7% ) . Nine cases with empyema were rinsed the pleural with metronidazole solution, whose hospitalization time was ( 25. 7 ±17. 4) days, and 8 were cured( 89. 0% ) . Compared with the tuberculous pleurisy patients, most CPPE and empyema occurred in middle and old aged patients with an average age of ( 63. 3 ±19. 3) years. Polykaryocyte and lactate dehydrogenase increased significantly. Adenosine deaminase ( ADA) was lt; 45 U/L in most UPPE and empyema patients, but was gt; 45 U/L in 7 cases ( 11% ) . Conclusions UPPE is simple and preferably treated with antibiotics alone. While CPPE and empyema should be drainaged as early as possible, and the low-dose urokinase may be helpful. The level of ADA can not absolutely distinguish parapneumonic effusion from tuberculous pleural effusion.
Objective To summarize the clinical features of lymphangioleiomyomatosis ( LAM) in Chinese population. Methods The first case of LAM in China was reported in 1981. All cases of LAM reported in Chinese literature from January 1981 to December 2009 were reviewed. The cases for analysis were included with a diagnosis of LAM confirmed or probable according to the guidelines of European Respiratory Society, and with individual clinical data available. Results A total of 111 cases of LAM werepooled for analysis. All cases were female. The most frequent onset symptomof LAMwas dyspnea ( 51. 4% ) .The main clinical manifestations included dyspnea ( 93. 4% ) , pneumothorax ( 48. 6% ) , cough ( 45. 7% ) ,hemoptysis ( 35. 1% ) , and chylothorax ( 33. 3% ) . 11 cases were associated with tuberous sclerosis complex.An obstructive with or without restrictive abnormality in pulmonary function testing was observed in 60 /67 cases. Diffusion impairment was also common ( 45 /46) . Of the 109 patients, computerized tomography of chest showed thin-walled air-filled cysts throughout both lungs in 104 cases, multiple bullae in 3 cases, andhoneycomb changes in 2 cases. 102 cases were diagnosed based on pathological findings. Misdiagnosis was found in 44 cases, the median time of misdiagnosis was 24 months. Conclusion Awareness of LAMshould be raised when an adult female who presents with an unexplained dyspnea, especially combined with repeatedpneumothorax or chylothorax.
Objective To evaluate the markers which contribute to diagnosis and prognosis of thyroid neoplasm. Methods The references about thyroid markers in recent years were reviewed. Results CD26 and galectin-3 could be regarded as a simple, potent markers to differentiate thyroid carcinoma in preoperative diagnosis, CD97 was a specific marker for undifferentiated thyroid carcinoma and its metastasis, CD15 and telomerase could be used in fine-needle aspirate biopsy (FNAB) of thyroid mass, and to improve its diagnostic evaluation, RET/PTC was mainly expressed in thyroid medullary carcinoma, oncofetal fibronectin (oncFN) was specific to papillary and anaplastic carcinoma, thyroid peroxidase was used to identify benign and malignant thyroid tumor. Conclusion Although there are a lot of markers for thyroid neoplasm, but there is no marker which are completely specific to certain histotype of thyroid neoplasm at present.
Objective To analyze the clinical characteristics and diagnostic methods of primary pulmonary cryptococcosis. Methods The medical records of adult HIV-negative patients diagnosed with primary pulmonary cryptococcosis between 2006 and March 2011 were reviewed retrospectively. Results 90 patients were enrolled in the study. The mean( ±SD) age was ( 46. 3 ±12. 42) years( range 19 to 71 years) . The clinical manifestations of pulmonary cryptococcosis were mild without obvious physical signs. The imaging features can be classified into 3 types. Nodule or mass type was common. The right lung and lower lobe were most commonly involved. There was no significant difference of the lesion type between the groups with or without underlying diseases ( P gt;0. 05) . Sputum or BALF culture for Cryptococcus neoformans yield no positive result. The main diagnostic methods were video-assisted thoracic surgery( VATS, 42 cases) , transbronchial lung biopsy( TBLB, 28 cases) and transthoracic needle aspiration biopsy( TNAB, 14 cases) . The latex agglutination( LA) test yield positive results in 31 patients out of 48 patients( 64. 58% ) . The LA test positive group often used TBLB as diagnostic method( 64. 52% ) .Meanwhile the LA test negative group and the group without LA test often used thoracoscope as diagnostic method( 47. 06% and 76. 19% ) . There was significant difference in diagnostic method between the three groups( P lt;0. 05) . Conclusions It is not impossible to acquire pulmonary cryptococcosis in immunocompetent patients. The clinical manifestations and imaging features of pulmonary cryptococcosis were lack of characteristics. The diagnosis level can be improved by invasive examination such as TBLB and TNAB. The LA test for Cryptococcus neoformans can be used as an early noninvasive diagnostic method.
The Standards of Medical Care in Diabetes released by the American Diabetes Association (ADA) is one of the most important guidelines for clinicians. Based on the latest evidence of clinical studies, the Standards of Medical Care in Diabetes is annually updated by ADA. The statements of ADA on diagnosis, assessment, and management in diabetes are recommended for clinicians, patients, and researchers. The latest edition of Standards of Medical Care in Diabetes was published in a supplementary issue of Diabetes Care in January 2018. This interpretation will focus on the updated contents and their best evidence and clinical importance in this guideline.
ObjectiveTo evaluate the value of carcinoembryonic antigen (CEA), ferritin, D-dimer, fibrinogen degradation product (FDP), white blood cell (WBC) and C-reactive protein (CRP) in diagnosis and prognosis of severe community-acquired pneumonia (SCAP).MethodsThis was a prospective observational study. One hundred and seventy-seven candidates were divided into 3 groups: SCAP group including 61 SCAP patients, CAP group including 56 patients with normal community-acquired pneumonia group and HP group including 60 healthy people. Initial level of above biomarkers was compared and analyzed in the three groups. Then the efficiency of diagnosing and predicting the outcome of SCAP by single and combined index were evaluated by receiver operating characteristic (ROC) curve. Meanwhile the patients in SCAP group were divided into two groups according to the CEA level named CEA increasing group and normal group, between which the differences in prognosis and biomarker level were compared.ResultsThe initial level of all biomarkers increased in two pneumonia groups and exceeded the HP group (P< 0.01) while between SCAP and CAP groups, all indexes in SCAP group were higher than the CAP group (P< 0.001). The areas under the ROC of CEA, ferritin, D-dimer, CRP, WBC and united respectively were 0.800, 0.834, 0.769, 0.898, 0.756 and 0.956. The sensitivity of united index was 91.8% while specificity was 90.5%. Among SCAP group, only CEA level made sense to predict the prognosis (P< 0.01). There were significant differences in intubation rate, mortality, length of RICU stay and FDP, D-dimer between CEA increasing group and normal group (P< 0.05).ConclusionsHigh level CEA, ferritin, D-dimer, CRP and WBC have significant value in diagnosis of SCAP. And the combined index has higher diagnostic value than single one. SCAP with increased CEA level indicates more serious condition and poor prognosis.
ObjectiveTo summarize the experience of diagnosis and treatment on primary gastric lymphoma. MethodsThirtyseven patients, proved by pathology, were included in the study. ResultsAmong clinical presentation, the upper abdominal pain, intestinal bleeding, and weight loss were common. Only 4 cases were diagnosed as PGL in 33 cases with the examination of Xray barium meal, 88.5% ( 23 of 26 cases) were missdiagnosed as gastric ulcer under gastroscopy. All cases underwent operation, among them 33 had been performed a radical operation. The survival period was over 5 years in 12 of 25 patients who have been followed up. ConclusionThe multiple biopsy sampling from submucosal layer via gastroscope may improve diagnostic rate on primary gastric lymphoma. Operative removal of the tumor should be the first choice of treatment. Additional chemotherapy after the surgery increases the fiveyear survival rate.
Objective To improve the diagnosis and treatment of complications following spleen transplantation. Methods Five cases of spleen transplantation performed to treat severe hemophilia A were analyzed retrospectively .Results Hemorrhage was found in 2 cases that one was from small vessels of spleen porta and the other one was retroperitoneal hemorrhage. Acute rejection was diagnosed in early stage to all in which it happened to 1 case within 5 days, happened to 3 cases from the fifth day to the tenth postoperative day and happened to 1 cases after the tenth day. Infection was found in 2 patientsone with incision infection and the other with infection retroperitoneal infection. All but one who died from hydrocephalus recovered as a result of timely diagnosis and treatment.Conclusion It is of great significance to the recipients with transplanted spleen that the complications are detected comprehensively and treated in time.
Objective To explore the injury mechanism, clinical features and treatment methods of multiple-level noncontiguous spinal fractures(MNSF). Methods The clinical data of 23 patients with MNSF were analyzed retrospectively. Therewere 15 males and 8 females aging from 13 to 75 years. Five cases missed diagnosis. The locations of the primary injury were cervical region in 3 cases, thoracic region in 7 cases, and thoracolumbar region in 13 cases. The spinal fractures associated with spinal cord injury were 14 cases in the primary injury, and 3 cases in the secondary injury. According to Frankel grade, there were 7 cases ofgrade A, 1 case of grade B, 3 cases of grade C, 6 cases of grade D and 6 cases of grade E. Sixteen cases were treated by surgical stabilization while 7 cases were treated conservatively. Results Twenty patients were followed up from 3 months to 4 years with a mean of 11.5 months except three patients. No neurologic deterioration was observed in patients who were treated conservatively or operatively. No wound infection, no implant failure or bone graft nonunion occurred in patients who were treated operatively. Among 17 patients with neurologic deficit before operation, 12 got 1-3 grade improvement of the Frankel grading, 4 remained unchanged and 1 died. Conclusion The mechanism of MNSF injury is complex, it is easy to miss diagnosis. The patients with spinal injury must be examined carefully and completely. A whole spine radiographic survey should be accomplished if necessary and treatments should be based on the stability of spine fractures and the severity of spinal cord injury.
From 1987 to 1993, 12 cases of primary gastric malignant lymphoma (PGML) were hospitalized. The incidence of PGML was 1.9% of gastric malignancies during the same period. There were 5 cases in stage Ⅰ, 4 in stage Ⅱ, 1 in stage Ⅲ, and 2 in stage Ⅳ. The preoperative diagnosis of PGML was difficult because the incidence of PGML is low, the symptoms are nonspecific, and the radiologic and fibrogastroscopic character were very similar to those of gastric carcinoma and peptic ulcer disease. The surgical treatment of PGML is disccused.
