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.
ObjectiveTo summary the diagnosis and surgical treatment experiences of posterior collicular fracture of medial malleolus. MethodsBetween March 2008 and November 2010, 14 patients having lateral and (or) posterior malleolus fractures with posterior collicular fracture of medial malleolus were treated with open reduction and internal fixation, including 5 males and 9 females with an average age of 44.5 years (range, 27-60 years). The causes of injuries were strain in 9 cases, traffic accident in 3 cases, and falling from height in 2 cases. The course of fracture ranged from 3 to 9 days (mean, 6.5 days). Fourteen cases were lateral malleolus fractures, 10 cases were posterior malleolus fractures. According to Lauge-Hansen classification, there were 8 cases of pronation-external rotation type, 3 cases of pronation-abduction type, and 3 cases of supination-external rotation type. ResultsAll incisions healed by first intention with no complication. The patients were followed up 12-24 months (mean, 16.8 months). The X-ray films showed that all fractures healed from 2 to 4 months after operation (mean, 2.9 months). The range of motion (ROM) of affected ankles was (38.40 ± 3.50)° of flexion and was (16.30 ± 2.41)° of extension, showing no significant difference when compared with ROM of normal side [(40.50 ± 3.48)° and (17.90 ± 2.28)°, P gt; 0.05]. All patients’ ankle function was evaluated by Olerud-Molander’s score criteria for ankle function evaluation, the results were excellent in 7 cases, good in 6 cases, and fair in 1 case. ConclusionSpiral CT plays an indispensable role in diagnosis of posterior collicular fracture of medial malleolus. Surgical reduction and rigid fixation should be performed.
This paper interprets 2017 European Society of Cardiology (ESC) peripheral arterial disease diagnosis and treatment guidelines on lower extremity arterial disease, and in order to provide reference for clinical practice.
Objective To improve the awareness of acute exacerbation of idiopathic pulmonary fibrosis ( AEIPF) and discuss its clinical characteristics, diagnosis, treatment and outcome. Methods The clinical data of patients with AEIPF from June 2006 to June 2011 in 11 hospitals in Jiangsu were collected and analyzed. Resluts There were 18 males and 3 females in the AEIPF patients with mean age of ( 67.4 ± 8.1) years. The duration from IPF diagnosis was ( 7.4 ±8.2) months. The duration of acute symptom before admission was ( 7.0 ±5.3) days. The distribution pattern of new groud-glass opacity was peripheral in 3 patients,multifocal in 5 patients, and diffuse in13 patients. All patients were treated with corticosteroid pulse therapy. Nine patients survived and 12 patients died. The mortality rate was 57.1% . Conclusions AEIPF progresses quickly and the mortality rate is very high. Corticosteroid pulse therapy is the mainstay of therapy in AEIPF patients.
【Abstract】 Objective To improve the knowledge of idiopathic pulmonary arterial hypertension ( IPAH) to elevate the levels of early diagnosis and treatment. Methods The clinical data of 39 IPAH patients admitted in Beijing Anzhen Hospital from October 1997 to June 2010 were reviewed. Results Of the 39 IPAH patients, 14 cases were male and 25 cases were female, with an average age of ( 29. 7 ±16. 4)years old. Main clinical manifestations were exertional dyspnea/breathlessness ( 90. 9% ) , chest tightness( 72. 7%) , chest pain ( 30. 7% ) , cough ( 41. 0% ) , fatigue ( 48. 7% ) , syncope ( 35. 9% ) , cyanosis( 28. 2% ) , edema of lower extremity ( 43. 6%) , etc. As revealed through echocardiography, 39 cases had a mean systolic pulmonary arterial pressure ( SPAP) of ( 88. 8 ±24. 2) mmHg, with right ventricle enlargementin 37 cases and normal in 2 cases. Pulmonary angiography showed central pulmonary arterial dilatation with pruning of the peripheral blood vessels in 36 cases and normal in 3 cases. Right heart catheterization and acute vasodilator testing was performed with iloprost in 15 patients, systolic pulmonary arterial pressure was( 77. 6 ±27. 8 ) mm Hg, and positive rate was 20. 0% . 24 cases were misdiagnosed at admission, and misdiagnosis rate was 61. 5% . The average time of misdiagnosis was ( 26. 0 ±24. 5) months. 20 cases were treated with general medical therapy and 1 case was managed with lung transplantation before April 2008.Then 13 cases were given pulmonary arterial hypertension-targeted therapies, including sidenafil, iloprost or bosentan. Two patients died in hospital with a mortality rate of 5. 1% . Conclusions IPAH is uncommon and often occurs in young and middle-aged women. The symptoms are nonspecific and easily misdiagnosed.Echocardiography and pulmonary angiography are helpful in diagnosis. Right heart catheterization and acute vasodilator testing should be carried out if available. The patients should be early treated with pulmonary arterial hypertension-targeted therapies. Lung transplantation may be an option for end-stage cases.
ObjectiveTo investigate the clinical value of real-time elastosonography in diagnosis of thyroid nodules. MethodsThe clinical date of 168 patients with thyroid nodules, admitted to our hospital from June 2009 to December, were retrospectively analyzed with pathological findings as the reference standard． The findings on elastography were classified into five grades: grade 0 to Ⅳ. The nodules with grade less than Ⅱ were diagnosed as benign, otherwise more than Ⅲ were diagnosed as malignancy. ResultsThere were 208 nodules in 168 patients: nodular goiter was in 125 cases, thyroid adenoma in 36 cases, thyroid malignant tumor in 41 cases including 39 cases for thyroid papillary carcinoma, 1 case for thyroid medullary carcinoma, 1 case for thyroid non-Hodgkin lymphoma. Other nodules were in 6 cases, including diffuse toxic goiter in 1 case, local lymphocytic thyroiditis in 3 cases, and subacute granulomatous thyroiditis in 2 cases. There were 148 thyroid nodules in grade 0-Ⅱ and 60 nodules in grade Ⅲ-Ⅳ. According to the pathological findings, 97.3%(144/148) thyroid nodules of grade 0-Ⅱ were benign, however, 38.3% (23/60) of grade Ⅲ-Ⅳ were benign. Furthermore, 2.7% (4/148) thyroid nodules of grade 0-Ⅱ were malignancy, while 61.7% (37/60) of grade Ⅲ-Ⅳ were malignancy. The sensitivity， specificity, and accuracy of the real-time elastosonography in diagnosis of thyroid nodules was 90.2%(37/41), 86.2%(144/167), and 87.0%(181/208), respectively. ConclusionReal-time elastosonography can reflect the relative hardness of thyroid nodules and provide useful information for diagnosis, which is helpful in differentiating benign and malignant thyroid nodules.
Objective To investigate the diagnostic value of MR imaging in cervical spinal canal stenosis combined with spinal cord injury. Methods From August 1998 to May 2008, 41 patients with cervical spinal canal stenosis and spinal cord injury were treated, including 34 males and 7 females aged 32-71 years (average 53.4 years, 27 patients being older than 60 years). Patients’ MRI data were retrospectively analyzed. Injury was caused by fall ing from height in 8 cases, traffic accidentin 19 cases, crush due to heavy objects in 3 cases and other reasons in 11 cases. The time from injury to operation ranged from 2 hours to 3 years. There were 12 cases of anterior spinal cord injury syndrome, 23 of central spinal cord syndrome and 6 of Brown-Sequard syndrome. JOA score of spinal cord function was 3-11 points (average 6.6 points). Results MR imaging diagnosis before operation showed abnormal signal changes within the spinal cord in 37 cases (41 sites), anterior and posterior longitudinal l igaments and discs (APLLD) injury in 28 cases (30 sites) and signal of edema and hematoma signals in anterior surface of cervical spines (EBC) in 34 cases (36 sites). Diagnosis during operation revealed edemas braises, contusions tears of posterior soft tissue in 18 cases (20 sites), appendix fracture in 6 cases (7 sites), formation of EBC in 20 cases (23 sites), APLLD injury in 34 cases (44 sites), intervertebral instabil ity without the rupture of l igament and intervertebral disc in 7 cases (10 sites). Significant difference was evident between the MRI diagnosis before operation and the intraoperative discoveries (P lt; 0.05). Conclusion The MR imaging diagnosis before operation do not correspond to the intraoperative discoveries, indicating that MRI diagnosis fails to make a relatively comprehensive and accurate diagnosis. So it is advisable to make a diagnosis based on cl inical symptoms.
Large cell neuroendocrine lung cancer（LCNEC） is the rare subtype of nonsmall cell lung cancer. Because of its low incidence rate and the special biological behaviour, it is hard to define in pathology. And we also know little about its epidemiological feature and the purposeful therapy view of LCNEC, and the therapeutic effect is unsatisfactory. This article will review and introduce the advance of research, clinical diagnosis and therapeutic of the LCNEC.
Objective To invesitgate the clinical characteristics, radiology, diagnosis and treatment of pulmonary cryptococcosis ( PC) . Methods The patients with PC diagnosed form January 2000 to January 2009 from three hospitals of Shanghai and Nanjing were retrospectively analyzed. Results A total of 34 patients were diagnosed, with 24 males and 10 females, and an average age of ( 40. 6 ±13. 5) years old ( ranged from 3 to 72 years) . Twelve patients had underlying diseases and 28 patients had symptoms. The main symptoms were pyrexia ( 20 cases) , cough and expectoration ( 22 cases) , chest pain ( 8 cases) , chest tightness ( 5 cases) , and hemoptysis ( 4 cases) . Seven cases were diagnosed as systemic pulmonary cryptococcosis, in which 3 cases were complicated with cryptococcal meningitis ( CM) , and 3 cases with CM and cryptococcal septicemia, and 1 cases with third dorsal vertebra Busse-Buschke disease. Radiologic manifestations showed multiformand nonspecific lesion such as nodus or nodules in 17 cases, pneumonia in 10 cases, mixed appearance in 6 cases, and diffused military nodes in 1 case. The diagnosis was confirmed by pathological study in 27 cases, including 12 cases by thoracotomy, 10 cases by percutaneous lung biopsy, 1 cases by thoracic vertebra biopsy, and 4 cases by bronchoscope. Ten cases were confirmed with culture positive or smear positive. Six cases were treated by surgery alone, 21 cases by antimycotic drug therapy alone, and 6 cases by drug therapy after surgery. One case quitted after the diagnosis. The duration of treatment varied from 2 weeks to 2 years. One case died in the hospital, 25 cases recovered after discharge, and 8 cases were lost to follow-up. Conclusions PC is likely to be misdiagnosed due to atypical clinical and image manifestations. The diagnosis is always comfirmed on the pathological and microbiological study.
ObjectiveTo investigate differential diagnosis between benign and malignant of solitary pulmonary nodules (SPN)and surgical strategies. MethodsWe retrospectively analyzed clinical and pathological data of 151 SPN patients who underwent surgical resection in Provincial Hospital Affiliated to Shandong University between November 2010 and March 2012. There were 89 male and 62 female patients with their age of 30-80 (57.99±0.86)years. Differential factors between benign and malignant SPN were analyzed. ResultsThere were 29 patients with benign SPN and 122 patients with malignant SPN. Among the 122 malignant SPN patients, there were 58 patients in stage ⅠA, 30 patients in stage ⅠB, 7 patients in stage ⅡA, 25 patients in stage ⅢA and 2 patients in stage Ⅳ. Mean diameter of malignant SPN was significantly larger than that of benign SPN (2.03 cm vs 1.77 cm, P=0.039). Malignant rate of SPN larger than 2 cm was significantly higher than that of SPN smaller than 2 cm (90.3% vs. 74.2%, P=0.013). Patients with malignant SPN was significantly older than patients with benign SPN (60.39 years vs. 47.90 years, P < 0.01). Malignant rate of patients over 45 years was significantly higher than that of patients younger than 45 years (86.4% vs. 38.9%, P < 0.01).There was no statistical difference in malignant rate between male and female, with and without clinical symptoms, smoking and nonsmo-king, smoking index≤400 and > 400 and among different lobes. Conclusions Differential factors of SPN include patients' medical history, age, diameter and shape of nodules, which should be considered comprehensively and dynamically. Gender, clinical symptoms, smoking history, smoking index and SPN location are not helpful for differential diagnosis of SPN.